ash 2014 vol 19 n3 eng

2014. Том 19, № 3

Подписной индекс по каталогу “Роспечати” 47434

РЕДАКЦИОННАЯ КОЛЛЕГИЯ:

2014. V. 19. N 3

EDITORIAL BOARD:Ахаладзе Г.Г. (Москва, Россия)Ахмедов С.М. (Душанбе, Таджикистан)Баймаханов Б.Б. (Алматы, Казахстан)Буриев И.М. (Москва, Россия)Бъёрн Эдвин (Осло, Норвегия)Ветшев П.С. (Москва, Россия) Ветшев С.П. (Москва, Россия) (научный редактор)Готье С.В. (Москва, Россия)Емельянов С.И. (Москва, Россия)Журавлев В.А. (Киров, Россия)Кармазановский Г.Г. (Москва, Россия)

(зам. главного редактора – распорядительный директор)

Котовский А.Е. (Москва, Россия)Кубышкин В.А. (Москва, Россия)Мамакеев М.М. (Бишкек, Киргизия)Манукян Г.В. (Москва, Россия)Наги Хабиб (Лондон, Великобритания)Назыров Ф.Г. (Ташкент, Узбекистан)Ничитайло М.Е. (Киев, Украина)Панченков Д.Н. (Москва, Россия)Патютко Ю.И. (Москва, Россия)Третьяк С.И. (Минск, Беларусь)Тулин А.И. (Рига, Латвия)Цвиркун В.В. (Москва, Россия)Шаповальянц С.Г. (Москва, Россия)Шулутко А.М. (Москва, Россия)

Akhaladze G.G. (Moscow, Russia)Akhmedov S.M. (Dushanbe, Tajikistan)Baymakhanov B.B. (Almaty, Kazakhstan)Bjorn Edwin (Oslo, Norway)Buriev I.M. (Moscow, Russia)Vetshev P.S. (Moscow, Russia) Vetshev S.P. (Moscow, Russia) (scientific editor)Gautier S.V. (Moscow, Russia)Emelianov S.I. (Moscow, Russia)Zhuravlev V.A. (Kirov, Russia)Karmazanovsky G.G. (Moscow, Russia)

(Associate Editor – Chief Executive)Kotovskiy A.E. (Moscow, Russia)Kubishkin V.A. (Moscow, Russia)Mamakeev M.M. (Bishkek, Kirgizia)Manukyan G.V. (Moscow, Russia)Nagy Habib (London, Great Britain)Nazirov F.G. (Tashkent, Uzbekistan)Nichitaylo M.E. (Kiev, Ukraine)Panchenkov D.N. (Moscow, Russia)Patyutko Yu.I. (Moscow, Russia)Tretyak S.I. (Minsk, Belarus)Tulin A.I. (Riga, Latvia)Tsvirkoun V.V. (Moscow, Russia)Shapovalyants S.G. (Moscow, Russia)Shulutko A.M. (Moscow, Russia)

Главный редактор Э.И. Гальперин (Москва, Россия)Зам. главного редактора В.А. Вишневский

(Москва, Россия)

Зам. главного редактора М.В. Данилов (Москва, Россия)Отв. секретарь Т.Г. Дюжева (Москва, Россия)

Editor/in/Chief E.I. Galperin (Moscow, Russia)Associate Editor V.А. Vishnevsky (Moscow, Russia)Associate Editor М.V. Danilov (Moscow, Russia)Secretary Editor Т.G. Dyuzheva (Moscow, Russia)

РЕДАКЦИОННЫЙ СОВЕТ: BOARD OF CONSULTANTS:

Адрес для корреспонденции:115446, Москва, Коломенский проезд, 4,

Клиническая больница № 7. Проф. Гальперину Э.И.Тел./факс (499) 782/34/68. E/mail: [email protected]

http://www.hepatoassociation.ru/journalООО “Видар” 109028, Москва, а/я 16.

Контакты (495) 768/04/34, (495) 589/86/60,http://www.vidar.ru

Address for Correspondence:Prof. Galperin E.I.,Hospital #7, Kolomensky pr. 4, Moscow, 115446 Russia.Tel/Fax + 7 (499) 782/34/68. E/mail: [email protected]://www. hepatoassociation.ru/journalVidar Ltd. 109028 Moscow, p/b 16.Contacts + 7 (495) 768/04/34, + 7 (495) 589/86/60,http://www.vidar.ru

Научно/практический журналОснован в 1996 г.

Регистр. № ПИ № ФС77/19824

Scientific and Practical JOURNALEst. 1996

Reg. № ПИ № ФС77/19824

Альперович Б.И. (Томск, Россия), Багненко С.Ф. (Санкт/Петербург, Россия), Бебезов Б.Х. (Бишкек, Киргизия),Бебуришвили А.Г. (Волгоград, Россия), Вафин А.З.(Ставрополь, Россия), Винник Ю.С. (Красноярск, Россия),Власов А.П. (Саранск, Россия), Гранов А.М. (Санкт/Петербург, Россия), Гришин И.Н. (Минск, Беларусь),Заривчацкий М.Ф. (Пермь, Россия), Каримов Ш.И.(Ташкент, Узбекистан), Красильников Д.М. (Казань, Россия),Лупальцев В.И. (Харьков, Украина), Полуэктов В.Л.(Омск, Россия), Прудков М.И. (Екатеринбург, Россия),Сейсембаев М.А. (Алматы, Казахстан), Совцов С.А.(Челябинск, Россия), Тимербулатов В.М. (Уфа, Россия),Чугунов А.Н. (Казань, Россия), Штофин С.Г.(Новосибирск, Россия)

Зав. редакцией Платонова Л.В.

Al'perovich B.I. (Tomsk, Russia), Bagnenko S.F.(St./Petersburg, Russia), Bebezov B.Kh. (Bishkek, Kirgizia),Beburishvili A.G. (Volgograd, Russia), Vafin A.Z. (Stavropol,Russia), Vinnik Yu.S. (Krasnoyarsk, Russia), Vlasov A.P.(Saransk, Russia), Granov A.M. (St./Petersburg, Russia),Grishin I.N. (Minsk, Belarus), Zarivchatski M.F.(Perm, Russia), Karimov Sh.I. (Tashkent, Uzbekistan),Krasilnikov D.M. (Kazan, Russia), Lupaltcev V.I. (Kharkov,Ukraine), Poluectov V.L. (Omsk, Russia), Prudkov M.I.(Ekaterinburg, Russia), Seysembayev M.A. (Almaty,Kazakhstan), Sovtsov S.A. (Chelyabinsk, Russia),Timerbulatov V.M. (Ufa, Russia), Chugunov A.N. (Kazan,Russia), Shtofin S.G. (Novosibirsk, Russia)

Chief of office Platonova L.V.

Журнал включен ВАК РФ в перечень ведущих рецензируемыхнаучных журналов и изданий, в которых должны быть опубли!кованы основные научные результаты диссертации на соисканиеученой степени доктора и кандидата наук.

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АННАЛЫХИРУРГИЧЕСКОЙ

ГЕПАТОЛОГИИ

ANNALS OF SURGICALHEPATOLOGYANNALY KHIRURGICHESKOY GEPATOLOGII

© МЕЖДУНАРОДНАЯ ОБЩЕСТВЕННАЯ ОРГАНИЗАЦИЯ

“АССОЦИАЦИЯ ХИРУРГОВ!ГЕПАТОЛОГОВ”

© INTERNATIONAL PUBLIC ORGANIZATION

“ASSOCIATION OF SURGICAL HEPATOLOGISTS”

ISSN 1995�5464 (Print)ISSN 2408�9524 (Online)

2

CONTENTS

ANNALS OF SURGICAL HEPATOLOGY 2014. V. 19. N 3

Publication Requirements . . . . . . . . . . . . . . . . . . . . . . . . . 4

Viktor Viktorovich Tsvirkoun –Editor of the Issue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

From Editor of the Issue . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The First Experience with Laparoscopic Surgery in Chronic Pancreatitis Patients

Khatkov I.E., Tsvirkoun V.V., Izrailov R.E., Alikhanov R.B., Andrianov A.V. . . . . . 10

Laparoscopically Assisted Liver Resection in a Patient with Severe Adhesions

Panchenkov D.N., Alikhanov R.B., Ivanov Yu.V.,Shablovsky O.R., Baranov A.V., Solovyov N.A.,Nechunaev A.A., Aleksanyan G.B. . . . . . . . . . . . . . . . 17

Laparoscopic Anatomical Liver Resection:Analysis of Personal Experience and Potential

Alikhanov R.B., Izrailov R.E., Tsvirkoun V.V., Khatkov I.E. . . . . . . . . . . . . . . . . . . . 21

Liver Failure after Operations on the LiverKhubutia M.Sh., Zhuravel S.V., Kuznetsova N.K., Vereshchagin A.S. . . . . . . . . . . . . . 27

Right Portal Vein Embolization in Patients with Liver Metastases

Shabunin A.V., Grecov D.N., Drozdov P.A. . . . . . . . . 33

Elastometry and Elastography in Differential Diagnosis of Hyperechoic Liver Masses

Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I., Makhotina M.S., Chuchuev E.S., Abirov K.E. . . . . . . . . . . . . . . . . . . . . 40

Simultaneous Surgery in Synchronous Colorectal Liver Metastases Patients

Shelygin Yu.A., Ponomarenko A.A., Panina M.V., Achkasov S.I., Kashnikov V.N., Rybakov E.G. . . . . . . . . . . . . . . . . . 46

Low�dose Computed Tomography with Bolus Contrast Enhancement in Estimation of Arterial Chemoembolization of the Liver and Pancreas

Tsygankov V.N., Frantsevich A.M., Varava A.B.,Karmazanovsky G.G., Tarbaeva N.V., Khachaturov A.A., Khovalkin R.G. . . . . . . . . . . . . . . 55

Prevention of Abdominal Echinococcosis Recurrence

Medjidov R.T., Sultanova R.S., Medjidov Sh.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Use of External Metallic Frame in Reconstructive Biliary Surgery

Karimov Sh.I., Khakimov M.Sh., Khadjibaev F.A., Tilemisov S.A.. . . . . . . . . . . . . . . . . 68

Diagnosis of Oddi Sphincter Dysfunction and Duodenal Dyskinesia in Patients with Postcholecystectomy Syndrome

Repin M.V., Popov A.V., Mikriukov V.Y., Repin V.N. . . . . . . . . . . . . . . . . . . . . 74

BILE DUCTS

LIVER

LAPAROSCOPIC LIVER AND PANCREATIC SURGERY

Pharmacological Correction of Biliary Outflow in Patients with Biliary Tract Malignancies

Yakovlev A.Y., Zaitsev R.R., Semyonov V.B.,Niyazmatov A.A., Zakharov A.G., Chichkanova A.S., Akulenko S.V., Vorontsov A.Y., Ulitin D.N. . . . . . . . . . . . . . . . . . . . . 81

Correction of Regional Blood Flow in Combined Therapyof Acute Pancreatitis Patients

Lubyanskii V.G., Arutyunyan G.A., Aliev A.R., Zharikov A.N.. . . . . . . . . . . . . . . . . . . . . . 86

No�touch Isolation of Pancreas: How I do itPart 1. Proximal Resection

Egiev V.V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Antibiotic Prophylaxis and Therapy of Infected Pancreatic Necrosis Adjusted for Gastric Microbial Indicators

Fomin A.V., Okulich V.K., Ovsianik D.M.. . . . . . . . . 99

The First Experience of a Two�stage “in situ split” Liver Resection in a Patient with Primary Unresectable Colorectal Cancer Liver Metastases after the Perioperative Chemotherapy

Sidorov D.V., Bolotina L.V., Lozhkin M.V., Grishin N.A., Petrov L.O., Troitsky A.A., Paychadze A.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Arterial Reconstruction in Patients with Proper Hepatic Artery Aneurysm

Novruzbekov M.S., Guliaev V.A., Olisov O.D., Lutsik K.N., Muslimov R.Sh., Magomedov K.M., Driaev V.T., Chernaya N.R. . . . 113

A Rare Diverse Complication of Cholelithiasis Kulchiev A.A., Morozov A.A., Tigiev S.V., Karaev T.R. . . . . . . . . . . . . . . . . . . . . . 118

Nine�year Survival Rate after Locoregional Treatment in a Patient with Hepatocellular Carcinoma

Dolgushin B.I., Kosyrev V.Y., Shishkina N.A. . . . . . 123

Double Biliary and Duodenal Stenting in Stenotic Pancreatic Tumor

Marinova L.A., Bachurin A.N., Chevokin A.Yu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Abstracts of Current Foreign PublicationsAkhaladze G.G., Akhaladze D.G. . . . . . . . . . . . . . . 133

Resolution of the IPO ”Association of SurgeonHepatologists” Executive Board Plenary Session,May, 15–16, 2014, Tyumen’, Russian Federation. . . . 138

Vyacheslav Petrovich ZemlyanoiTo 65th Anniversary . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Mahmut Ahmet�Valeevich Galeev . . . . . . . . . . . . . . . . 143

OBITUARY

JUBILEES

CHRONICLE

ABSTRACTS

CASE REPORTS

PANCREAS

3



The First Experience with Laparoscopic Surgery The First Experience with Laparoscopic Surgery in Chronic Pancreatitis Patientsin Chronic Pancreatitis Patients

Khatkov I.E.1, 2

, Tsvirkoun V.V.1, Izrailov R.E.

1, 2, Alikhanov R.B.

1, 3, Andrianov A.V.

1

1 Moscow Clinical Scientific Center, Moscow; 86, Shosse Entuziastov, Moscow, 111123, Russian Federation

2 Chair of Surgery, Moscow State University of Medicine and Denistry; 20, Delegatskaya str., Moscow, 127473,

Russian Federation3 Chair of Surgery of the Faculty of Fundamental Medicine of Lomonosov Moscow State University;

20/5, Lomonosovskiy prospect, Moscow, 119192, Russian Federation

Key words: chronic pancreatitis, laparoscopic surgery, Frey’s procedure, pancreatojejunostomy, cystoenterostomy, cystoje�

junostomy.

Aim. To improve the outcomes of surgery in patients with chronic pancreatitis by implementation of laparoscopic tech�

niques.

Materials and Methods. From December 2012 to January 2014 at Moscow Clinical Research and Practical Center of

Moscow Department of Healthcare laparoscopic surgery was performed in 13 chronic pancreatitis patients with chron�

ic pancreatitis, including two cases of cystoenterostomy, three cases of longitudinal pancreatojejunostomy, four cases of

Frey's procedure, one case of longitudinal pancreatojejunostomy with cystoenterostomy and three cases of pancreato�

duodenal resections. Simultaneous operations were carried out in 5 of those cases, including two cholecystectomies, one

Nissen fundoplication, one removal of the right adrenal gland affected by tumor, and one laparoscopic postoperative

ventral hernia repair. The mean size of the pancreatic head was 39.3 mm (29 to 50 mm). The size of postnecrotic cysts

was 74 and 130 mm. The mean diameter of the main pancreatic duct was 7.5 mm (5 to 12 mm).

Results. Operating time varied from 215 to 500 min. In all cases blood loss came to less than 200 ml. In 11 cases the sur�

gery was completely laparoscopic. Postoperative complications occurred in 2 patients. Development of pancreatic fistu�

la was observed after longitudinal pancreatojejunostomy, and its closure was obtained conservatively in 19 days. Bleeding

from jejunal erosion wall was observed after a pancreatoduodenectomy, and was also controlled conservatively. Mean

postoperative length of stay was 9 days after cystoenterostomy, pancreatojejunostomy and Frey's procedure, and 12 days

after pancreatoduodenal resection. No deaths followed the surgery in this series.

Conclusion. This first experience shows that laparoscopic interventions are feasible and safe although understudied

approach to the treatment of chronic pancreatitis.

Khatkov Igor Evgenievich – Doct. of Med. Sci., Professor, Head of Moscow Clinical Scientific Center, Head of Chair of Surgery,

Moscow State University of Medicine and Dentistry. Tsvirkoun Viktor Viktorovich – Doct. of Med. Sci., Professor, Chief Researcher

of Moscow Clinical Scientific Centre. Izrailov Roman Evgenyevich – Doct. of Med. Sci., Head of Department of Surgery of Moscow

Clinical Scientific Centre, Professor of Chair of Faculty Surgery of Moscow State University of Medicine and Dentistry. AlikhanovRuslan Bogdanovich – Cand. of Med. Sci., Associate Professor, Chief of Surgery of Liver and Pancreas of Moscow Clinical

Scientific Centre, Head of the Curriculum Department of Chair of Surgery of the Faculty of Fundamental Medicine of Lomonosov

Moscow State University. Andrianov Aleksey Vladimirovich – Postgraduate, Moscow Clinical Scientific Centre.

For correspondence: Andrianov Aleksey Vladimirovich – Apt. 209, 9/7, Tepliy Stan str., Moscow, 117465, Russian Federation.

Phone: +7�903�140�1682. E�mail: [email protected]

References1. Nacional'nye klinicheskie rekomendacii po khirurgicheskomu lecheniju bol'nyh hronicheskim pankreatitom [National clinical recommendation

on the surgical treatment of the chronic pancreatitis patients]. 2013. 43 p. (In Russian)

2. Kubyshkin V.A. Hronicheskij pankreatit [Chronic pancreatitis]. Clinical surgery. Moscow: GEOTAR�Media, 2009. P. 495–512. (In

Russian)

3. Galperin E.I. Lektsii po gepatopankreatobiliarnoj khirurgii [Lections in hepato�pancreato�biliary surgery]. Moscow: Vidar�M, 2011. P.

375–403. (In Russian)

4. Danilov M.V., Fedorov V.D. Khirurgija podzheludochnoj zhelezy [The pancreatic surgery]. Moscow: Meditsina, 1995. 510 p. (In Russian)

5. Egorov V.I., Vishnevsky V.A., Shastny A.T., Shevchenko T.V., Zhavoronkova O.I., Petrov R.V., Poltoracky M.V., Melekhina O.V. Resection of

the head of the pancreas by chronic pancreatitis. What to do and how to call it? (analytic review). Khirurgija. Zhurnal im. N.I. Pirogova.

2009; 8: 57–66. (In Russian) PMID: 19798776.

6. Maev I.V., Kazjulin A.N., Kucherjavyj J.A. Hronicheskij pankreatit [Chronic pancreatitis]. Moscow: Meditsina, 2005. 504 p. (In Russian)

4


7. Propp A.R., Polujektov V.L., Lobanov V.G., Arestovich R.A., Prankevich N., Astankov R.A., Kuz'menko V.V. Methods of intraductal pan�

creatic hypertension resotion. Khirurgija. Zhurnal im. N.I. Pirogova. 2011; 6: 32–37. (In Russian). PMID: 21716216.

8. Braganza J.M., Lee S.H., McCloy R.F., McMahon M.J. Chronic pancreatitis. Lancet. 2011; 377 (9772): 1184–1197. DOI:

10.1016/S0140�6736(10)61852�1. PMID: 21397320.

9. Beger H.G., Matsuno S., Cameron J.L. Diseases of the Pancreas. B.: Springer, 2008. 905 p.

10. Sarr M.G. Podzheludochnaja zheleza. Atlas khirurgii verkhnikh otdelov zheludochno�kishechnogo trakta, pecheni, podzheludochnoj zhelezy i

zhelchnykh putej [The pancreas. Atlas of Upper Gastrointestinal and Hepato�Pancreato�Biliary Surgery]. Moscow: BINOM, 2009. P.


11. Kochatkov A.V., Kriger A.G., Berelavichus S.V., Korolev S.V., Svitina K.A., Kosova I.A. The resection of the head of the pancreas with

longitudinal pancreatojejunostomy (Frey procedure). Khirurgija. Zhurnal im. N.I. Pirogova. 2012; 2: 31–36. (In Russian) PMID: 22678472.

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gicheskoy gepatologii. 2007; 12 (3): 119–120. (In Russian)

13. Khatkov I.E., Tsvirkun V.V., Agapov V.K., Izrailov R.E., Bagdatyeva M.G., Paklina O.V., Kulezneva Ju.V. Laparoscopic pancreaticoduo�

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5



Laparoscopically Assisted Liver Resection Laparoscopically Assisted Liver Resection in a Patient with Severe Adhesionsin a Patient with Severe Adhesions

Panchenkov D.N.1, 3

, Alikhanov R.B.2, Ivanov Yu.V.

1, 3, Shablovsky O.R.

1, 3,

Baranov A.V.1, 3

, Solovyov N.A.1, 3

, Nechunaev A.A.1, 3

, Aleksanyan G.B.1

1 A.I. Evdokimov Moscow State University of Medicine and Dentistry; 20, Delegatskaya str., Moscow, 127473,

Russian Federation2 M.V. Lomonosov Moscow State University; 1, Leninskie Gory, Moscow, 119991, Russian Federation

3 Federal Research Clinical Center of Specialized Medical Care and Medical Technologies FMBA Russia;

28, Orekhovy boulevard, Moscow, 115682, Russian Federation

Authors present a case report of laparoscopically assisted liver resection in a patient with metastasis of gastric cancer in

the liver segment 3. The patient previously underwent subtotal gastrectomy for well differentiated adenocarcinoma.

In this case, the use of laparoscopic technique for liver resection, being in full compliance with the principles of surgical

oncology, have ensured all the known advantages of laparoscopic surgery, providing reduced hospitalization time and

rehabilitation period.

Key words: laparoscopic liver resection, liver, adhesions, gastric cancer, metastases, conversion.

Panchenkov Dmitry Nikolaevich – Doct. of Med. Sci., Professor, Head of Department of Surgery FCME A.I. Evdokimov

Moscow State University of Medicine and Dentistry. Alikhanov Ruslan Bogdanovich – Cand. of Med. Sci., Associate Professor,

Department of Surgery of M.V. Lomonosov Moscow State University. Ivanov Yury Victorovich – Doct. of Med. Sci., Professor

of Surgery of the Department of Surgery FCME A.I. Evdokimov Moscow State University of Medicine and Dentistry, Head of

the Division of Surgery Federal Research Clinical Center FMBA of Russia. Shablovsky Oleg Radomirovich – Doct. of Med. Sci.,

Professor of Surgery of the Department of Surgery FCME A.I. Evdokimov Moscow State University of Medicine and Dentistry,

Director of the Institute of Clinical Surgery Federal Research Clinical Center FMBA of Russia. Baranov Aleksey Viktorovich –

Cand. of Med. Sci., Senior Researcher, Laboratory of Minimally Invasive Surgery A.I. Evdokimov Moscow State University of

Medicine and Dentistry, Head of the Laboratory of Minimally Invasive Technologies of the Institute of Clinical Surgery Federal

Research Clinical Center FMBA of Russia. Solovyov Nikolai Alekseevich – Doct. of Med. Sci., Associate Professor of Surgery

A.I. Evdokimov Moscow State University of Medicine and Dentistry. Surgeon, Division of Surgery, Federal Research Clinical

Center FMBA of Russia. Nechunaev Alexey Aleksandrovich – Cand. of Med. Sci., Assistant Professor, Department of Surgery

FCME A.I. Evdokimov Moscow State University of Medicine and Dentistry. Aleksanyan Gayane Babkenovna – Fellow,

Department of Surgery FCME A.I. Evdokimov Moscow State University of Medicine and Dentistry.

For correspondence: Panchenkov Dmitry Nikolaevich – b. 1, 20, Delegatskaya str., Moscow, 127423, Russian Federation.

Phone: +7�916�589�66�46. E�mail: [email protected]

References

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2. Tomishige H., Morise Z., Kawabe N., Nagata H., Ohshima H., Kawase J., Arakawa S., Yoshida R., Isetani M. Caudal approach to pure

laparoscopic posterior sectionectomy under the laparoscopy�specific view. World J. Gastrointest. Surg. 2013; 5 (6): 173–177. doi:

10.4240/wjgs.v5.i6.173. PMID: 23977419.

3. Buell J.F., Cherqui D., Geller D.A., O’Rourke N., Iannitti D., Dagher I., Koffron A.J., Thomas M., Gayet B., Han H.S., Wakabayashi G.,

Belli G., Kaneko H., Ker C.G., Scatton O., Laurent A., Abdalla E.K., Chaudhury P., Dutson E., Gamblin C., D'Angelica M., Nagorney D.,

Testa G., Labow D., Manas D., Poon R.T., Nelson H., Martin R., Clary B., Pinson W.C., Martinie J., Vauthey J.N., Goldstein R., Roayaie

S., Barlet D., Espat J., Abecassis M., Rees M., Fong Y., McMasters K.M., Broelsch C., Busuttil R., Belghiti J., Strasberg S., Chari R.S.

The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann. Surg. 2009; 250 (5): 825–830. PMID: 19916210.

4. Emelyanov S.I., Alikhanov R.B., Panchenkov D.N., Matveev N.L., Kudryavtsev P.V., Pankratov A.Yu., Veredchenko A.V. First experience

of laparoscopic left bisegmentectomy at bilobar liver metastases. Annaly khirurgicheskoy gepatologii. 2005; 10 (3): 73–85. (In Russian)

5. Jacoby V.L., Autry A., Jacobson G., Domush R., Nakagawa S., Jacoby A. Nationwide use of laparoscopic hysterectomy compared with

abdominal and vaginal approaches. Obstet. Gynecol. 2009; 114 (5): 1041. doi: 10.1097/AOG.0b013e3181b9d222. PMID: 20168105.

6. Park S.H., Cho H.Y., Kim H.B. Factors determining conversion to laparotomy in patients undergoing total laparoscopic hysterectomy.

Gynecol. Obstet. Invest. 2011; 71 (3): 193–197. doi: 10.1159/000317520. PMID: 21160145.

7. Dubuisson J., Botchorishvili R., Perrette S., Bourdel N., Jardon K., Rabischong B., Canis M., Mage G. Incidence of intraabdominal adhe�

sions i continuous series of 1000 laparoscopic procedures. Am. J. Obstet. Gynecol. 2010; 203 (2): 111. e1�3. doi: 10.1016/j.ajog.2010.03.031.

PMID: 20537306.

6



Laparoscopic Anatomical Liver Resection:Laparoscopic Anatomical Liver Resection:Analysis of Personal Experience and PotentialAnalysis of Personal Experience and Potential

Alikhanov R.B., Izrailov R.E., Tsvirkoun V.V., Khatkov I.E.

Moscow Clinical Scientific Center, Moscow; 86, Shosse Entuziastov, Moscow, 111123, Russian Federation

Aim. To analyze personal experience with laparoscopic liver resection (LLR) and to assess the potential for minimal

access resection surgery.

Materials and Methods. A total of 35 LLRs were performed during the period from 2010 to 2013. Anatomical LLRs were

carried out in 25 patients (men – 13; women – 25; average age 52.7 years). Laparoscopic hemihepatectomy was done in

4, bisegmentectomy in 15, and isolated segmentectomy in 6 patients. Surgical technique of anatomical LLR varied

depending on extent of surgery, localization and character of the lesion. In 4 cases of hepatocellular carcinoma the sur�

gery was performed in the setting of Child�Pugh class A cirrhosis.

Results. The mean values for surgery duration and intra�operative blood loss were 180 min (70�470 min) and 290 ml

(100–600 ml) respectively. The maximum blood loss was observed in a patient with cirrhosis during hepatic parenchy�

ma dissection. In all patients with malignancies, resection margins were free from tumor growth. Conversion was per�

formed in one case of giant hemangioma on the finishing stage of hemihepatectomy to prevent blood loss from subseg�

mental branches of hepatic veins and to ensure adequate hemostasis of the liver cut surface. In one patient with hepato�

cellular carcinoma and cirrhosis, ascites persisted for a long time (3 weeks) after resection of segment 6 of the liver, before

resolution in response to diuretics and intravenuous albumin. Subhepatic abscess developed in one case and was com�

pletely resolved within 12 days after the operation with drainage and lavage with antiseptic solutions. There were no

deaths following the surgery in this series.

Conclusion. Anatomical LLR is an effective and promising procedure when performed by surgeons provided with suffi�

cient pre� and intraoperative diagnostic data, having adequate equipment and experience in hepatology and laparoscop�

ic techniques. Use of laparoscopic access is acceptable for treatment of practically all kinds of liver lesions and should be

widely adopted in specialized clinics in Russia.

Key words: laparoscopy, liver resection, laparoscopic liver resection.

Alikhanov Ruslan Bogdanovich – Cand. of Med. Sci., Associate Professor, Head of Hepatopancreatobiliary Department of Moscow

Clinical Scientific Center. Izrailov Roman Evgenyevich – Doct. of Med. Sci., Professor, Head of Surgical Department of Moscow

Clinical Scientific Center. Tsvirkun Viktor Viktorovich – Doct. of Med. Sci., Professor, Chief Surgeon of Moscow Clinical Scientific

Center. Khatkov Igor Evgenyevich – Doct. of Med. Sci., Professor, Director of Moscow Clinical Scientific Center.

For correspondence: Alikhanov Ruslan Bogdanovich – 45�149, Novokosinskaya str., Moscow,111672, Russian Federation.

Phone: 8�903�766�33�17. E�mail: [email protected]

References 1. Gigot J.F., Glineur D., Santiago Azafra J., Goergen M., Ceuterick M., Morino M., Etienne J., Marescaux J., Mutter D., van

Krunckelsven L., Descottes B., Valleix D., Lachachi F., Bertrand C., Mansvelt B., Hubens G., Saey J.P., Schockmel R. Laparoscopic

resection for malignant liver tumors: preliminary results of a multicenter European study. Ann. Surg. 2002; 236 (1): 90–97. PMID:

12131090.

2. Cherqui D. Laparoscopic liver resection. Br. J. Surg. 2003; 90 (6): 644–646. PMID: 12808610.

3. Kaneko H. Laparoscopic hepatectomy: indication and outcomes. J. Hepatobiliary Pancreat. Surg. 2005; 12 (6): 438–443. PMID: 16365815.

4. Chmanadra T.C., Mierdl S., Bauer H., Gutt C., Hanisch E. Transesophageal echocardiography show high risk of gas embolism during

laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. Br. J. Surg. 2002; 89 (7): 870–876. PMID: 12081736.

5. Takagi S. Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum during laparoscopic hepatectomy. Surg. Endosc.

1998; 12 (5): 427–431. PMID: 9569363.

6. Gutt C.N., Riemer V., Kim Z.G., Erceg J., Lorenz M. Impact of laparoscopic surgery on experimental hepatic metastasis. Br. J. Surg. 2001;

88 (3): 371–375. PMID: 11260101.

7. Targarona E.M., Martinez J., Nadal A., Balague C., Cardesa A., Pascual S., Trias M. Cancer dissemination during laparoscopic surgery:

tube, gas, and cells. World J. Surg. 1998; 22 (1): 55–61. PMID: 9465762.

8. Jantukhanova S.V., Starkov Yu.G., Shishin K.V. Laparoscopic liver resections. Current status of problem. Khirurgija. Zhurnal im. N.I.

Pirogova. 2009; 12: 63–67. (In Russian)

9. Starkov Yu.G.,Vishnevskiy V.A., Shishin K.V., Solodinina E.N., Domarev L.V., Kobesova T.A. Laparoscopic procedures in focal lesions of

the liver. Khirurgija. Zhurnal im. N.I. Pirogova. 2006; 2: 24–29. (In Russian) PMID: 16715976.

7


10. Emeljanov S.I., Alikhanov R.B., Panchenkov D.N., Matveev N.L., Kudrjavtsev P.V., Pancratov A.Yu., Veredchenko A.V. First experience

of laparoscopic lateral bisegmentectomy in bilobar metastatic lesions of liver. Annaly khirurgicheskoy gepatologii. 2007; 12 (4): 11–14. (In

Russian)

11. Alexandrov K.R., Zhao A.V., Illarionov I.Yu, Utkin D.I., Yurov V.B., Burya R.A. Laparoscopicheskaya pravostoronyaya gemigepatektomiya

[Laparoscopic right hemihepatectomy]. Programme of XII congress of Russian Society of Endoscopic Surgeons. Moscow, 2009. P. 36. (In

Russian)

12. Tsvirkoun V.V., Khatkov I.E., Izrailov R.E., Agapov K.V., Tumanov A.B., Dzugkoeva F.A. Endovideosurgical technology of liver resection.

Annaly khirurgicheskoy gepatologii. 2010; 15 (2): 38–45. (In Russian)

13. Mala T., Edwin B., Rosseland A.R., Gladhaug I., Fosse E., Mathisen O. Laparoscopic liver resection experience of 53 procedures at a sin�

gle center. J. Hepatobiliary Pancreat. Surg. 2005; 12 (4): 298–303. PMID: 16133696.

14. Buell J.F., Koffron A.J., Thomas M.J., Rudich S., Abecassis M., Woodle E.S. Laparoscopic liver resection. J. Am. Coll. Surg. 2005; 200 (3):

472–480. PMID: 15737861.

15. Vibert E., Perniceni T., Levard H., Denet C., Shahri N.K., Gayet B. Laparoscopic liver resection. Br. J. Surg. 2006; 93 (1): 67–72. PMID:

16273531.

16. Belli G., Fantini C., D’Agostino A., Cioffi L., Langella S., Russolillo N., Belli A. Laparoscopic versus open liver resection for hepatocel�

lular carcinoma in patients with histologically proven cirrhosis: short� and middle�term results. Surg. Endosc. 2007; 21 (11): 2004–2011.

PMID: 17705086.

17. Cherqui D., Laurent A., Tayer C., Chang S., van Nhieu J.T., Loriau J., Karoui M., Duvoux C., Dhumeaux D., Fagniez P.L. Laparoscopic

liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann. Surg.

2006; 243 (4): 499–506. PMID: 16552201.

8


LIVER

Liver Failure after Operations on the LiverLiver Failure after Operations on the Liver

Khubutia M.Sh., Zhuravel S.V., Kuznetsova N.K., Vereshchagin A.S.

Sklifosovsky Research Institute for Emergency Medicine; 3, bld. 5, B. Sukharevskaya sq., Moscow, 129090,

Russian Federation

Aim. To analyze the development of liver failure and the efficiency of various methods of treatment after liver resection

and transplantation.

Material and Methods. Analysis of liver failure prevalence, treatment efficiency and outcomes of 150 liver resections and

cadaveric liver transplantations was carried out at Sklifosovsky Institute for Emergency Medicine.

Results. Postresectional acute liver failure developed in 1 (0.7%) patient after extended right hemihepatectomy due to

a functional failure of patient's remnant liver parenchyma (segments I, II, III). The patient then underwent liver trans�

plantation. In patients who underwent liver transplantation, liver failure syndrome was observed in 20 (8,6%) cases due

to poor function of the graft or the complete lack thereof. Extracorporeal albumin and adsorption dialysis were per�

formed in 12 patients who developed acute liver failure after liver transplantation. Two patients with non�functional graft

underwent retransplantation of the liver. Eight patients received renal replacement therapy in a form of extended

hemodiafiltration. Mortality from acute liver failure among patients who underwent liver transplantation came to 70%

(14 patients out of 20).

Conclusion. Application of extracorpoteal adsorption dialysis may help to achieve complete recovery of graft function or

to prepare a patient for liver retransplantation. The liver transplantation or retransplantation is a radical choice in man�

agement of liver failure after liver resection or transplantation.

Key words: liver failure, liver transplantation, extracorporeal adsorption dialysis.

Khubutia Mogeli Shalvovich – Doct. of Med. Sci., Professor, Corresponding Member of the Academy of Medical Sciences,Director of Sklifosovsky Research Institute for Emergency Medicine. Zhuravel Sergey Vladimirovich – Doct. of Med. Sci.,Head of Department Anesthesia and Intensive Care for Organ Transplant, Sklifosovsky Research Institute for EmergencyMedicine. Kuznetsova Natalia Konstantinovna – Cand. of Med. Sci., Senior Research Fellow, Department Anesthesia andIntensive Care for Organ Transplant, Sklifosovsky Research Institute for Emergency Medicine. Vereshchagin Alexey Sergeevich –Anesthesiologist�Reanimatologist, Department Anesthesia and Intensive Care for Organ Transplant, Sklifosovsky ResearchInstitute for Emergency Medicine.

For correspondence: Kuznetsova Natalia Konstantinovna – 3, bld. 5, B. Sukharevskaya sq., Moscow, 129090, RussianFederation. Phone: 8�495�628�35�02. E�mail: [email protected]

References1. Galperin E.I., Semendyаeva M.M., Nekludova E.A. Nedostatochnost' pecheni [Liver failure]. Moscow: Medicine, 1978. 328 p. (In Russian)

2. Pasechnic I.N., Kutepov D.E. Pechenochnaja nedostatochnost': sovremennye metody lechenija [Liver failure: modern methods of treatment].

Moscow: Medicinskoye informacionnoye agentstvo, 2009. 234 p. (In Russian)

3. Broelsch C.E., Malago M., Testa G., Valentin Gamazo C. Living donor liver transplantation in adults: outcome in Europe. Liver Transpl.

2000; 6 (6) Suppl. 2: S64–S65. PMID: 11084088.

4. Imamura H., Seyama Y., Kokudo N., Maema A., Sugawara Y., Sano K. One thousand fifty�six hepatectomies without mortality in 8 years.

Arch. Surg. 2003; 138 (11): 1198–1206. PMID: 14609867.

5. Jarnagin W.R., Gonen M., Fong Y., De Matteo R.P., Ben�Porat L., Little S. Improvement in perioperative outcome after hepatic resection:

analysis of 1,803 consecutive cases over the past decade. Ann. Surg. 2002; 236 (4): 397–406. PMID: 12368667.

6. Schindl M.J., Redhead D.N., Fearon K.C.H., Garden O.J., Wigmore S.J. The value of residual liver volume as a predictor of hepatic dys�

function and infection after major liver resection. Gut. 2005; 54 (2): 289–296. PMID: 15647196.

7. Schroeder R.A., Marroquin C.E., Bute B.P., Khuri S., Henderson W.G., Kuo P.C. Predictive indices of morbidity and mortality after liver

resection. Ann. Surg. 2006; 243 (3): 373–379. PMID: 16495703.

8. Denisova E.N., Sharipova V.R., Purlo N.V., Sukhanova G.A., Biryukova L.S. The use of plasma fractionation separation and adsorption

in the treatment of acute liver failure. Anesthesiologia i reanimatologia. 2009; 2: 45–49. (In Russian)

9. Chikoteev S.P., Plekhanov A.N., Kornilov N.G. Current views on the liver regeneration. Khirurgia. Zhurnal im. N.I. Pirogova. 2001; 6:

59–62. (In Russian). PMID: 11517706.

10. Uryvaeva I.V. Replicative potential of hepatocytes and stem cells of the liver. Izvestija RAN. Serija Biologicheskaja. 2001; 6: 728–737. (In

Russian). PMID: 15926339.

11. Starzl T.E., Demetris A.J., van Thiel D. Liver transplantation (2). N. Engl. J. Med. 1989; 321 (16): 1092–1099. PMID: 2677722.

12. Balzan S., Belghiti J., Farges O., Ogata S., Sauvent A., Delefosse D., Durand F. The “50–50 criteria” on postoperative day 5: an accurate

predictor of liver failure and death after hepatectomy. Ann. Surg. 2005; 242 (6): 824–828. PMID: 16327492.

13. Mullen J.T., Ribero D., Reddy S.K., Donadon M., Zorzi D., Gautam S., Abdalla E.K., Curley S.A., Capussotti L., Clary B.M., Vauthey

J.N. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J. Am. Coll. Surg. 2007; 204 (5):

854–862. PMID: 17481498.

14. Takaya S., Doyle H., Todo S., Irish W., Fung J.J., Starzl T.E. Reduction of primary nonfunction with prostaglandin E1 after clinical liver

transplantation. Transplant. Proc. 1995; 27 (2): 1862–1867. PMID: 7725533.

9


LIVER

Right Portal Vein Embolization in Patients Right Portal Vein Embolization in Patients with Liver Metastaseswith Liver Metastases

Shabunin A.V.1, Grecov D.N.

1, Drozdov P.A.

2

1 The Russian Academia for Post�Graduate Education; 2/1, Barrikadnaya str., Moscow, 123995, Russian

Federation2 S.P. Botkin City Clinical Hospital; 5, 2nd Botkinsky proezd, Moscow,125284, Russian Federation

Aim. To improve resectability in patients with liver metastases.

Material and Methods. Embolization of the right branch of the portal vein was performed in 15 patients. Liver metas�

tases from colorectal, kidney and cervical cancer were observed in 13 (86.8%), 1 (6.66%) and 1 (6.66%) patients respec�

tively. In all patients, according to abdominal CT, future liver remnant sizes were less than 30% (17–27%). Mean liver

volume and mean volume of the left lobe were 1256 ± 102.32 cm3 and 289 ± 31.08 cm3 (19.78%) respectively.

Results. Average increase in liver volume and volume of the left lobe were 12.5% and 41.7% respectively. Expected hyper�

trophy of the left lobe of the liver was not obtained in 1 (6.66%) patient. In the remaining 14 (93.3%) patients the left

lobe volume had increased up to 30% and higher. Mean liver volume and mean volume of the left lobe after emboliza�

tion were 1413 ± 105.51 cm3 and 487 ± 56.81 cm3 respectively. Radical surgery was performed in 9 (60%) patients:

extended right hemihepatectomy was done in 5 (33.3%) patients and right hemihepatectomy was carried out in

4 (26,6%) patients. Specific complications occurred in 2 (20%) patients: one case of incomplete external biliary fistula

and one case of acute liver failure. Complications in both cases were resolved with conservative treatment. There was

1 death from acute cerebrovascular accident. Overall mortality was 10%, and median survival time was 32 months.

Conclusion. Embolization of the right branch of the portal vein in most cases ensures vicarious hypertrophy of the left

lobe of the liver sufficient for further surgery.

Key words: liver, metastases, portal vein embolization, liver resection, hemihepatectomy.

Shabunin Alexey Vasil'evich – Doct. of Med. Sci., Head of Chair of Hospital Surgery the Russian Academia for Post�Graduate

Education, Head of S.P. Botkin City Clinical Hospital. Grecov Dmitrii Nicolaevich – Cand. of Med. Sci., Physician�Surgery,

S.P. Botkin City Clinical Hospital. Drozdov Pavel Alexeevich – Physician�Surgery, S.P. Botkin City Clinical Hospital.

For correspondence: Drozdov Pavel Alexeevich – Apt. 8, 15, M. Brusilova str., Moscow, 117148. Phone: 7�962�985�04�41.

E�mail: [email protected]

References1. Foster G.H., Lundy J. Liver metastases. Curr. Probl. Surg. 1981; 18 (3): 160–195. PMID: 7016459.

2. Iwatsuki S., Sheahan D.G., Starzl T.E. The changing face of hepatic resection. Curr. Probl. Surg. 1989; 26 (5): 281–379. PMID: 2653737.

3. Pickren J.W., Tsukada Y., Lane W.W. Liver metastases: Analysis of autopsy data. In: Weiss L., Gilbert H.A. Liver metastases. Boston: G.K.

Hall Medical Pliblishers, 1982. P. 2–18.

4. Petrenko K.N., Polishchuk L.O. Radiochastotnaya ablatsia zlokachestvennikh novoobrazovaniyi. Sovremennoe sostoyanie voprosa

[Radiofrequency ablation of malignant neoplasms. Modern state of the isuue]. RZHGGK. 2007; 2. (In Russian)

5. Patyutko Y.I., Polyakov A.N. Combined treatment of colorectal cancer patients with liver metastases. Khirurgija. Zhurnal im. N.I. Pirogova.

2008; 7: 20–23. (In Russian)

6. Adam R., Bismuth H. Repeat hepatectomy for colorectal cancer liver metastases. Ann. Surg. 1997; 225 (1): 51–62. PMID: 8998120.

7. Dudarev V.S. Minimally invasive techniques in the treatment of malignant liver tumors. Oncologicheskii zhurnal. 2007; 2: 76–84. (In

Russian)

8. Axel E.M., Barmina N.M. Colorectal cancer (incidence, mortality, and social�economic loss). Rossijskij onkologicheskij zhurnal. 1999; 6:

40–46.

9. Patyutko Y.I. Khirurgicheskoe lechenie zlokachestvennyh opuholej pecheni [Surgical treatment of malignant liver tumors]. Moscow, 2005. 12

p. (In Russian)

10. Patyutko Y.I. Liver resection: modern technology in tumor lesions. Annaly khirurgicheskoy gepatologii. 2010; 15 (2): 9–17. (In Russian)

11. Patyutko Y.I. Surgical treatment of primary liver cancer. Prakticheskaja onkologija. 2008; 9 (4): 197–201. (In Russian)

12. Rous P., Larimore Ld. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J.

Еxp. Med. 1920; 31 (5): 609–632. PMID: 19868417.

13. Vishnevsky V.A., Kubyshkin V.A., Zhao A.V., Ikramov R.Z. Operacii na pecheni. [Hepatic resection]. Moscow: Miklosh, 2003. 157 р. (In

Russian)

14. Abulkhir A., Limongelli P., Healey A.J., Damrah O., Tait P., Jackson J., Habib N., Jiao L.R. Preoperative portal vein embolization for

major liver resection: a meta�analysis. Ann. Surg. 2008; 247 (1): 49–57. PMID: 18156923.

10


15. Zhao W.Y., Luo M., Sun Y.W., Xu Q., Chen W., Zhao G., Wu Z.Y. The efficacy of preoperative portal vein embolization for extended hepa�

tectomy: a meta�analysis. Zhonghua Wai Ke Za Zhi. 2008; 46 (19): 1460–1464. PMID: 19094621.

16. Rauchfuss F., Scheuerlein H., Lopatta E., Dittmar Y., Schule S., Settmacher U. Portal vein embolisation prior to extended liver resection

– current and future aspects. Zentralbl. Chir. 2013; 138 (4): 442–448. doi: 10.1055/s�0032�1328350. PMID: 23950080.

17. Mkrtchyan G.S. Rentgenjendovaskuljarnaja jembolizacija pri zlokachestvennyh opuholjah gepatopankreatoduodenal'noj zony [Endovascular

embolization in malignant tumors gepatopancreatoduodenal zone: dis. ... cand. of med. sci.]. Moscow, 2009. 100 р. (In Russian)

18. Tarazov P.G., Granov D.A., Polikarpov A.A. Preoperative embolization of the portal vein in patients with malignant liver tumors. Al'manah

instituta khirurgii imeni A.V. Vishnevskogo. 2008; 3 (3): 23–28. (In Russian)

19. Biryukov A.Y. Dvukhjetapnye operacii pri metastazah kolorektal'nogo raka v pecheni [Two�stage surgery for colorectal metastases cancer in

the liver: dis. ... cand. of med. sci.]. Moscow, 2012. 119 р. (In Russian)

20. Parkin D.M., Whelan S.L., Ferlay J., Teppo L., Thomas D.B. Cancer incidence in five continents. Vol. VIII. IARC. Scientific Publications

No.155. Lyon: IARC Press, 2002. 831 р.

11


LIVER

Elastometry and Elastography in Differential Diagnosis Elastometry and Elastography in Differential Diagnosis of Hyperechoic Liver Massesof Hyperechoic Liver Masses

Berdnikov S.N.1, Sholokhov V.N.

1, Patyutko Yu.I.

2,

Makhotina M.S.1, Chuchuev E.S.

2, Abirov K.E.

2

1 Division of Ultrasonic Diagnostics of the Department of Beam Diagnostics and Roentgen�Surgical Methods of

Treatment and 2 Surgical Department of the Tumors of the Liver and the Pancreas, N.N. Blokhin Russian Cancer

Research Center of RAMSci; 24, Kashirskoe shosse, Moscow, 115478, Russian Federation

Aim. To enhance the application of elastometry and elastography in differential diagnosis of hyperechoic liver lesions

(hemangiomas and colorectal metastases).

Materials and Methods. The total of 78 patients aged 32–62 years with hyperechoic liver neoplasms were examined with

manual compression elastography as well as acoustic radiation force impulse (ARFI) elastography, and shear wave veloc�

ity (SWV) elastometry.

Results. On manual compression elastograpy images, colorectal metastases appeared as stiff lesions in 71.1% of cases,

whereas hemangiomas appeared as soft lesions in 87.9% of cases. On ARFI elastography images, the lesions appeared

stiff and soft in 71.1% and 87.9% for colorectal metastases and hemangiomas respectively. Elastometry of colorectal

metastases showed high SWV rates: 3.24 m/s (1.4–4.22 m/s) with median velocity of 3.38 m/s. Liver hemangiomas

appeared to have the lowest SWV rates: 1.07 m/s (0.75–3.86 m/s) with median velocity of 0,93 m/s. Sensitivity, accura�

cy and positive predictive value of manual compression elastography in colorectal liver metastases were 97.78%, 97.78%

and 100% respectively. Specificity of manual compression elastography in liver hemangiomas was 93.94%, accuracy –

93.94, and negative predictive value – 100%. Sensitivity of ARFI elastography in colorectal liver metastases was 100%,

accuracy – 100% and negative prognostic value – 100%. Specificity, accuracy and positive predictive value of ARFI elas�

tography in liver hemangiomas were 93.94%, 100% and 100% respectively. Elastometry was shown to be more informa�

tive as to malignant tumors detection with SWV threshold set to 2.0 m/s (SWV exceeds 2.0 m/s – the tumor is malig�

nant; SWV is lower than 2.0 m/s – the tumor is benign). Accuracy of this test was 94%, sensitivity – 91%, specificity –

97%, positive prognostic value – 96.8%, and negative prognostic value – 91.6%.

Conclusion. Elastometry and elastography are highly informative methods for differential diagnosis of hyperechoic liver

lesions.

Key words: liver, hemangioma, metastasis, colorectal cancer, elastography, elastometry, acoustic radiation force impulse,

ARFI, shear wave velocity, SWV.

Berdnikov Sergey Nikolaevich – Graduate Student of the Department of Ultrasonic Diagnostics of the Division of Beam

Diagnostics and Roentgen�Surgical Methods of Treatment, N.N. Blokhin RCRC of RAMSсi. Sholokhov Vladimir Nikolaevich –

Doct. of Med. Sci., Professor, Сhief Scientific of the Department of Ultrasonic Diagnostics of the Division of Beam Diagnostics

and Roentgen�Surgical Methods of Treatment, N.N. Blokhin RCRC of RAMSсi. Patyutko Yuri Ivanovich – Doct. of Med. Sci.,

Professor, Head of Department of Tumors of the Liver and the Pancreas, N.N. Blokhin RCRC of RAMSсi. Makhotina MariaSergeevna – Cand. of Med. Sci., Ultrasonic Diagnostics Department of the Division of Beam Diagnostics and Roentgen�

Surgical Methods of Treatment, N.N. Blokhin RCRC of RAMSсi. Chuchuev Eugeny Stanislavovich – Scientific Worker of the

Department of the Tumors of the Liver and the Pancreas, N.N. Blokhin RCRC of RAMSсi. Abirov Kubanychbek Esenalievich –

Graduate Student of the Department of the Tumors of the Liver and the Pancreas, N.N. Blokhin RCRC of RAMSсi.

For correspondence: Berdnikov Sergey Nikolaevich – Apt. 143, 31/1, Moskvorechye str., 115409. Phone: +7�916�990�79�07.


References1. Borsukov A.V. Jelastografija v klinicheskoj gepatologii [Elastography in clinical hepatology]. Smolensk: Smolensk city printing house, 2011.

215 p. (In Russian).

2. Nightingale K., Soo M.S., Nightingale R., Trahey G. Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibil�

ity. Ultrasound Med. Biol. 2002; 28 (2): 227–235. PMID: 11937286.

3. Nightingale K., McAleavey S., Trahey G. Shear�wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med.

Biol. 2003; 29 (12): 1715–1723. PMID: 14698339.

4. Melodelima D., Bamber J.C., Duck F.A., Shipley J.A. Transient elastography using impulsive ultrasound radiation force: a preliminary

comparison with surface palpation elastography. Ultrasound Med. Biol. 2007; 33 (6): 959–969. PMID: 17445967.

5. Garra B.S. Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q. 2007; 23 (4): 255–268. PMID: 18090836.

12


LIVER

Feasibility of Simultaneous Surgery Feasibility of Simultaneous Surgery in Synchronous Colorectal Liver Metastases Patients in Synchronous Colorectal Liver Metastases Patients

Shelygin Yu.A.1, 2

, Ponomarenko A.A.1, Panina M.V.

1,

Achkasov S.I.1, Kashnikov V.N.

1, Rybakov E.G.

1

1 State Research Centre of Coloproctology; 2, Salyam Adil str., Moscow, 123423, Russian Federation

2 Chair of Coloproctology, Russian Medical Academy of Postgraduate Education; 2/1, Barikadnaja str.,

Moscow, 123995, Russian Federation

Aim. To evaluate results of simultaneous and staged surgery in patients with advanced colorectal cancer.

Material and Methods. A total of 54 liver resections were conducted in patients with colorectal metastases. Group I

included 25 patients with synchronous liver metastases who underwent simultaneous liver and colorectal resections.

Group II comprised 15 patients with synchronous liver metastases who underwent two�stage operations. The first stage

entailed the resection of the primary tumor, followed by liver resection at the second stage. Group III included

14 patients with metachronous colorectal liver metastases.

Results. Median blood loss came to 300 ml in synchronous metastases patients (groups I and II), and 150 ml for patients

with metachronous metastases (group III) (p = 0.008). Postoperative complications whre observed in 11, 7 and 5 patients

of groups I, II and III respectively (p = 0.8). Median postoperative hospital stay came to 16 (13:27) days, 18.5 (12:22) days

and 9 (8:14) days for groups I, II and III respectively. One patient in group II had died, thus overall mortality rate was 2%.

Conclusion. Simultaneous colorectal and liver resections or hemihepatectomy are associated with an acceptable compli�

cation rate. Staged surgery can potentially decrease the risk of poor clinical outcome in patients with multiple bilobar

metastases.

Key words: colorectal cancer, liver metastasis, simultaneous surgery, postoperative complications.

Shelygin Yurij Anatol'evich – Doct. of Med. Sci., Professor, Director of State Research Centre of Coloproctology, Head of the

Chair of Сoloproctology Russian Medical Academy of Postgraduate Education. Ponomarenko Aleksej Alekseevich – Cand. of

Med. Sci., Researcher at the Department of Oncoproctology of State Research Centre of Coloproctology. Panina MarijaViktorovna – Cand. of Med. Sci., Oncologist of the Department of Oncoproctology of State Research Centre of Coloproctology.

Achkasov Sergej Ivanovich – Doct. of Med. Sci., Head of the Department of Surgery and Oncology Colon of State Research

Centre of Coloproctology. Kashnikov Vladimir Nikolaevich – Cand. of Med. Sci., Wice Director of State Research Centre of

Coloproctology. Rybakov Evgenij Gennad'evich – Doct. of Med. Sci., Head of the Department of Oncoproctology of State

Research Centre of Coloproctology.

For correspondence: Ponomarenko Aleksej Alekseevich – 13�5, Samarkandvsky Boulevard, apt. 28, Moscow, 109507, Russia.Phone: +7�926�462�37�11. E�mail: [email protected]

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13


Patjutko Yu.A., Pylev A.L., Sagajdak I.V., Kotel'nikov A.G., Podluzhnyj D.V., Poljakov A.N., Ivanov A.A., Chuchuev E.S., Mamontov

K.G., Ponomarenko A.A. Modern concept of treatment for liver metastases of colorectal origin. Vestnik khirurgicheskoy gastroenterologii.

2008; 4: 14–28. (In Russian)

7. Thelen A., Jonas S., Benckert C., Spinelli A., Lopez�Hanninen E., Rudolph B., Neumann U., Neuhaus P. Simultaneous versus staged liver

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14. Narita M., Oussoultzoglou E., Fuchshuber P., Pessaux P., Chenard M.P., Rosso E., Nobili C., Jaeck D., Bachellier P. What is a safe future

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chemotherapy? Ann. Surg. Oncol. 2012; 19 (8): 2526–2538. doi: 10.1245/s10434�012�2274�x. PMID: 22395987.

15. Wen P.H., Lin K.H., Chen Y.L., Hsieh C.E., Ko C.J., Kuo S.J. Extracorporeal hepatic resection and autotransplantation using temporary

portocaval shunt provides an improved solution for conventionally unresectable HCC. Dig. Dis. Sci. 2013; 58 (12): 3637–3640. doi:

10.1007/s10620�013�2801�z. PMID: 23918151.

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(POT) strategy for synchronous colorectal liver metastasis (SCLM): feasibility study for staged resection in patients with a long POT. J.

Gastrointest. Surg. 2013; 17 (4): 688–695. doi: 10.1007/s11605�013�2163�z. PMID: 23404172.

17. Hillingso J.G., Wille�Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer – a systematic

review. Colorectal Dis. 2009; 11 (1): 3–10. doi: 10.1111/j.1463�1318.2008.01625.x. PMID: 18637099.

18. Slesser A.A., Simillis C., Goldin R., Brown G., Mudan S., Tekkis P.P. A meta�analysis comparing simultaneous versus delayed resections

in patients with synchronous colorectal liver metastases. Surg. Oncol. 2013; 22 (1): 36–47. doi: 10.1016/ j.suronc.2012.11.002. PMID:

23253399.

19. Weber J.C., Bachellier P., Oussoultzoglou E., Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metas�

tases. Br. J. Surg. 2003; 90 (8): 956–962. PMID: 12905548.

20. Nordlinger B., Guiguet M., Vaillant J.C., Balladur P., Boudjema K., Bachellier P., Jaeck D. Surgical resection of colorectal carcinoma

metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie.

Cancer. 1996; 77 (7): 1254–1262. PMID: 8608500.

21. Adam R., De Gramont A., Figueras J., Guthrie A., Kokudo N., Kunstlinger F., Loyer E., Poston G., Rougier P., Rubbia�Brandt L.,

Sobrero A., Tabernero J., Teh C., van Cutsem E. The oncosurgery approach to managing liver metastases from colorectal cancer: a multi�

disciplinary international consensus. Оncologist. 2012; 17 (10): 1225–1239. doi: 10.1634/theoncologist.2012�0121. PMID: 22962059.

22. Schmoll H.J., van Cutsem E., Stein A., Valentini V., Glimelius B., Haustermans K., Nordlinger B., van de Velde C.J., Balmana J., Regula

J., Nagtegaal I.D., Beets�Tan R.G., Arnold D., Ciardiello F., Hoff P., Kerr D., Kohne C.H., Labianca R., Price T., Scheithauer W., Sobrero

A., Tabernero J., Aderka D., Barroso S., Bodoky G., Douillard J.Y., El Ghazaly H., Gallardo J., Garin A., Glynne�Jones R., Jordan K.,

Meshcheryakov A., Papamichail D., Pfeiffer P., Souglakos I., Turhal S., Cervantes A. ESMO Consensus Guidelines for management of

patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann. Оncol. 2012; 23 (10): 2479–2516. PMID:

23012255.

23. Alexiou V.G., Tsitsias T., Mavros M.N., Robertson G.S., Pawlik T.M. Technology�assisted versus clamp�crush liver resection: a systemat�

ic review and meta�analysis. Surg. Innov. 2013; 20 (4): 414�428. doi: 10.1177/1553350612468510. PMID: 23242518.

24. Mullen J.T., Ribero D., Reddy S.K., Donadon M., Zorzi D., Gautam S., Abdalla E.K., Curley S.A., Capussotti L., Clary B.M., Vauthey

J.N. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J. Am. Coll. Surg. 2007; 204 (5):

854–862; discussion 862–864. PMID: 17481498.

25. Jarnagin W.R., Gonen M., Fong Y., DeMatteo R.P., Ben�Porat L., Little S., Corvera C., Weber S., Blumgart L.H. Improvement in peri�

operative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann. Surg. 2002; 236 (4): 397–406; dis�

cussion 407. PMID: 12368667.

26. Capussotti L., Ferrero A., Vigano L., Ribero D., Lo Tesoriere R., Polastri R. Major liver resections synchronous with colorectal surgery. Ann.

Surg. Oncol. 2007; 14 (1): 195–201. PMID: 17080238.

27. Slesser A.A., Chand M., Goldin R., Brown G., Tekkis P.P., Mudan S. Outcomes of simultaneous resections for patients with synchronous

colorectal liver metastases. Eur. J. Surg. Oncol. 2013; 39 (12): 1384–1393. doi: 10.1016/j.ejso.2013.09.012. PMID: 24080198.

14


LIVER

Low�dose Computed Tomography Low�dose Computed Tomography with Bolus Contrast Enhancement in Estimation of Arterial with Bolus Contrast Enhancement in Estimation of Arterial Chemoembolization of the Liver and PancreasChemoembolization of the Liver and Pancreas

Tsygankov V.N., Frantsevich A.M., Varava A.B., Karmazanovsky G.G.,

Tarbaeva N.V., Khachaturov A.A., Khovalkin R.G.

A.V. Vishnevsky Institute of Surgery; 27, B. Serpukhovskaya str., Moscow, 117997, Russian Federation

Aim. To assess the significance of the low�dose CT with bolus contrast enhancement (CT�angiography) for planning of

transarterial chemoembolization in liver and pancreatic malignancies patients.

Materials and Methods. From 2011 to 2013 chemoembolization was performed in 33 patients at A.V. Vishnevsky

Institute of Surgery, with a total number of interventions comprising 48. In 30 (90,9%) patients with hepatic tumors

45 (93.75%) interventions were done. 3 (9.1%) patients with pancreatic cancer after cryoablation underwent 3 surgical

procedures performed according to the method of Central Research Institute of Roentgenology. In 21 (63.6%) cases sur�

gical interventions were performed only one time, in 10 (30.4%) cases – two times, in 1 (3%) patient the surgery was per�

formed three times, and it was done four times also in 1 (3%) patient. All patients before chemoembolization underwent

low�dose CT�angiography using interactive reconstruction techniques.

Results. In all cases chemoembolization was fully implemented and good angiographic result was achieved. With CT�

angiography it is possible to obtain an accurate image of the collateral circulation in the basin of the superior mesenteric

artery and celiac trunk, to visualize stenotic or occlusive lesions thereof, to measure the angle between aorta and celiac

trunk. Normal anatomy of celiac�mesenteric complex (in accordance with N. Michels classification) was observed

in 16 (48,5%) patients. “Standard” chemoembolization was performed only in 16 (33.3%) cases due to variations in

anatomy and existing stenotic and occlusive lesions of the mesenteric arteries.

Conclusion. Low�dose CT angiography makes it possible to examine all the arteries of celiac�mesenteric complex with

minimal patient radiation exposure. CT�scans obtained with this method provide good understanding of all anatomical

details and abilities to choose the best option for surgery, thus reducing operative time and medical personnel exposure

to radiation.

Key words: computed tomography, angiography, chemoembolization, anatomy, liver, pancreas.

Tsygankov Vladimir Nikolaevich – Cand. of Med. Sci., Head of the Endovascular Diagnostic and Treatment Methods

Department of A.V. Vishnevsky Institute of Surgery. Franzevich Aleksey Mikhaylovich – Junior Research Fellow of the Endo�

vascular Diagnostic and Treatment Methods Department of A.V. Vishnevsky Institute of Surgery. Varava Aleksey Borisovich –

Junior Research Fellow of the Endovascular Diagnostic and Treatment Methods Department of A.V. Vishnevsky Institute of

Surgery. Karmazanovsky Grigory Grigorevich – Doct. of Med. Sci., Professor, Chief of Radiology Methods of Diagnostics and

Treatment Department of A.V. Vishnevsky Institute of Surgery. Tarbaeva Natalia Viktorovna – Cand. of Med. Sci., Researcher

of Radiology Methods of Diagnostics and Treatment Department of A.V. Vishnevsky Institute of Surgery. KhachaturovAleksander Aleksandrovich – Cand. of Med. Sci., Research Fellow of Endovascular Diagnostic and Treatment Methods

Department of A.V. Vishnevsky Institute of Surgery. Khovalkin Ruslan Gennadievich – Junior Research Fellow of Endovascular

Diagnostic and Treatment Methods Department of A.V. Vishnevsky Institute of Surgery.

For correspondence: Tsygankov Vladimir Nikolaevich – 27, B. Serpukhovskaya str., Moscow, 117997, Russian Federation,

Vishnevsky Institute of Surgery. Phone: 8�903�149�88�00. E�mail: [email protected]

References1. Virshke Je.R. Rentgenojendovaskuljarnye tehnologii v lechenii bol'nyh so zlokachestvennymi opuholjami pecheni i podzheludochnoj zhelezy

[Endovascular techniques in the treatment of the liver and pancreas malignant tumor patients: dis. … doct. of med. sci.]. Moscow, 2009.

161 p. (In Russian)

2. Balahnin P.V. Znachenie variantov arterial'noj anatomii pecheni dlja vypolnenija intervencionno�radiologicheskih vmeshatel'stv [Significane of

the liver arterial anatomy atiants in interventional radiological interventions: dis. … cand. of med. sci.]. Saint�Petersburg, 2012. 182 p. (In

Russian)

3. Lim H.S., Jeong Y.Y., Kang H.K., Kim J.K., Park J.G. Imaging features of hepatocellular carcinoma after transcatheter arterial chemoem�

bolization and radiofrequency ablation. Am. J. Roentgenol. 2006; 187 (4): W341–W349. PMID: 16985104.

15


4. Generalov M.I., Balahnin P.V., Rutkin I.O., Maistrenko D.N., Tcurcan V.A., Polikarpov A.A., Tarazov P.G., Granov D.A., Polysalov V.N.,

Krotova O.A., Kalashnikov P.A., Ivanova A.A. Methods of the liver arterial blood supply correction for subsequent implantation of the

“port�catheter” infusion system. Angiologiya i sosudistaya khirurgiya. 2009; 15 (2): 49–53. (In Russian)

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ja arterij v lechenii bol'nyh rakom golovki podzheludochnoj zhelezy. Materialy 9�j mezhregional'noj nauchno�prakticheskoj konferencii

“Aktual'nye voprosy intervencionnoj radiologii (rentgenokhirurgii)” [Oil arterial chemoembolization arteries in patients with cancer of the

pancreatic head. Materials of the 9th interregional scientific�practical conference “Actual issues of interventional radiology (x�ray sur�

gery)”]. 2009. P. 36–37. (In Russian)

6. Balahnin P.V., Hanevich M.D., Manihas G.M., Kukanov M.A., Zorina E.Yu., Antimonik N.Yu., Anosov N.A., Fridman M.Kh., Dinikin

M.S. Chastota razvitija i prichiny povrezhdenija arterij pecheni pri provedenii povtornyh kursov himiojembolizacii lekarstvenno�nasyshhaemy�

mi gepasferami. Materialy 2�j nauchno�prakticheskoj konferencii s mezhdunarodnym uchastiem “Aktual'nye voprosy intervencionnoj radiologii:

Profilaktika, diagnostika i lechenie oslozhnenij” [Incidence and causes liver arteries injury during repeated courses of chemoembolization

drug�eluted hepasphers. The materials of the 2nd scientific�practical conference with international participation “Current issues of inter�

ventional radiology: Prevention, diagnostics and treatment of complications”]. 2011. P. 69. (In Russian)

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Tomogr. 1992; 16 (6): 916–920. PMID: 1430441.

8. Valls C., Pamies J.�J., Sancho C. Computed tomography after Lipiodol chemoembolization in hepatocellular carcinoma. Eur. Radiol.

1994; 4 (3): 238–242.

9. Goldberg S.N., Ahmed M. Minimally invasive image�guided therapies for hepatocellular carcinoma. J. Clin. Gastroenterol. 2002; 35 (5

Suppl. 2): S115–S129. PMID: 12394215.

10. Huang J.�H., Fan W.�J., Li C.�J., Gu Y.K., Zhang L., Gao F., Lu L.W., Li W.Q. Application of multislice spiral CT angiography on tran�

scatheter arterial chemoembolization for hepatocellular carcinoma. Chin. J. Cancer. 2009; 28 (2): 159–163. PMID: 19550129.

11. Pavlovskij A.V., Tarazov P.G., Granov D.A. Sposob lechenija zlokachestvennyh opuholej podzheludochnoj zhelezy [A method of pancreatic

malignant tumors treatment]. Patent № 2156137 from 20.09.2000. (In Russian)

12. Michels N.A. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Philadelphia: Lippincott, 1955. 246 p.

16


LIVER

Prevention of Abdominal Echinococcosis RecurrencePrevention of Abdominal Echinococcosis Recurrence

Medjidov R.T.1, Sultanova R.S.

1, Medjidov Sh.R.

2

1 Dagestan State Medical Academy, Republic of Dagestan, Makhachkala; 1, R. Gamzatov prospekt,

Russian Federation2 Republican Clinical Hospital, Makhachkala; Republic of Dagestan, 47, str. Lyakhov, Makhachkala,

Russian Federation

Aim. To study surgical aspects of prevention of abdominal echinococcosis recurrence with improvement of aparasitory

and antiparasitory principles as well as introduction of new resection techniques.

Materials and Methods. Abdominal echinococcectomy was conducted in 720 patients with 947 cysts. Closed echinococ�

cectomy was performed in 190 (23.6%) patients, open echinococcectomy – in 378 (52.8%), combination of these oper�

ations – in 152 (20.9%) patients. In 47 cases the modern resection techniques were used.

Results. Intraoperative complications occurred in 4.2% of patients, and 14.8% of patients developed postoperative com�

plications. Specific complications in late postoperative period were observed in 22.3% of patients. Recurrence of

echinococcosis took place in 3.1% and 18.6% of patients after closed and open echinococcectomy respectively. The total

postoperative mortality was 2.7%.

Conclusion. Closed echinococcectomy should be the method of choice in abdominal echinococcosis due to minimal

recurrence rates. If possible, the modern surgical technics should be used for closed echinococcectomy, such as ultra�

sonic dissectors and destructors�aspirators.

Key words: echinococcosis, recurrence, prevention, closed echinococcectomy, resection techniques.

Medjidov Rasul Tenchaevich – Doct. of Med. Sci., Head of Departament of General Surgery, Dagestan State Medical Academy.

Sultanova Roza Sultanovna – Postgraduate, Departament of General Surgery, Dagestan State Medical Academy. MedjidovShamil Rasulovich – Surger, Republican Clinical Hospital, Makhachkala.

For correspondence: Medjidov Rasul Tenchaevich – 1, R. Gamzatov prosp., Makhachkala, Republic of Dagestan, 367012,

Russian Federation, Dagestan State Medical Academy. Phone: +7� 928�507�57�58. Е�mail: [email protected]

References1. Kurbonov K.M., Daminova N.M., Kasymov Kh.S. Comparative evaluation of methods of surgical treatment of the liver echinococcosis

patients. Annaly khirurgicheskoy gepatologii. 2008; 13 (1): 42–46. (In Russian)

2. Vishnevskiy V.A., Efanov M.G., Ikramov R.Z., Nazarenko N.A. Radical surgery for primary and residual liver echinococcosis. Annaly

khirurgicheskoy gepatologii. 2011; 16 (4): 25. (In Russian)

3. Nazirov F.G., Devyatov A.B., Akbarov M.M., Makhmudov U.M., Babadjanov A.Kh. Chemotherapy and problems of recurrent hepatic

echinococcosis. Annaly khirurgicheskoy gepatologii. 2011; 16 (4): 19–24. (In Russian).

4. Akhmedov I.G. Pathogenetic substantiation of the definition of “relapse of hydatid disease”. Annaly khirurgii. 2004; 2: 73–76. (In Russian)

5. Nazirov F.G., Devyatov A.B., Makhmudov U.M. Controversial issues and causes of reoperation in echinococcosis. Annaly khirurgicheskoy

gepatologii. 2007; 12 (1): 29–55. (In Russian)

6. Nazirov F.G., Ismailov D.A., Leonov V.F. Jehinokokkoz [Echinococcosis]. Tashkent, 1999. 207 р. (In Russian)

7. Musaev G.Kh., Kharnas S.S., Lotov A.N., Kashevarov S.B., Ligonkov Y.A. Modern approaches to the treatment of echinococcosis

patients. Annaly khirurgicheskoy gepatologii. 2002; 7 (1): 322–323. (In Russian)

8. Sielaff T.D., Taylor B., Langer B. Recurrence of hydatid disease. Wоld J. Surg. 2001; 25 (1): 83–86. PMID: 11213160

9. Lotov A.N., Chernaya N.R., Bugaev S.A., Lutsyk K.N., Rozinov V.M., Belyaev O.A., Petlakh V.I., Zhao A.V., Zhavoronkova O.I.,

Kondrashin S.A., Goremykin I.V., Filippov Y.V. Saving surgery for the liver hydatidosis. Annaly khirurgicheskoy gepatologii. 2011; 16 (4):

11. (In Russian)

10. Medjidov R.T., Aliev M.A., Gamzatov R.M., Medjidov Sh.R. Surgical treatment of abdominal echinococcosis. Annaly khirurgicheskoy

gepatologii. 2007; 12 (1): 43. (In Russian)

11. Vetshev P.S., Musaev G.Kh. Modern view on the state of art for echinococcosis. Annaly khirurgicheskoy gepatologii. 2006; 11 (1): 26–30.

(In Russian)

12. Teggi A., Di Vico B. Treatment of human cystic echinococcosis with benzimidazolecarbbamates. XXth International Congress of

Hydatilogy. 2001. 4–8 June. Kusadasi (Turkey). 2001; 45–46.

13. Vafin A.Z., Aydemirov A.N., Popov A.V. Classification of surgical treatment of echinococcosis. Annaly khirurgicheskoy gepatologii. 2000; 5

(2): 19–20. (In Russian)

14. Akhmedov I.G. Recidiv jehinokokkovoj bolezni: patogeneticheskie aspekty, profilaktika, rannjaja diagnostika i lechenie [Recurrence of hydatid

disease: pathogenetic aspects, prevention, early diagnosis and treatment: dis. … doct. med. sci.]. Makhachkala, 2006. 252 p. (In Russian)

15. Prousalidis J., Kosmidis C., Antimidis G., Kapoutzis K., Karamanlis E., Fachantidis E., Can J. Postoperative recurrence of cystic hidati�

dosis. Can. J. Surg. 2011; 55 (1): 15–20. doi: 10.1503/cjs.013010. PMID:21939605.

17


BILE DUCTS

Use of External Metallic Frame Use of External Metallic Frame in Reconstructive Biliary Surgeryin Reconstructive Biliary Surgery

Karimov Sh.I.1, Khakimov M.Sh.

1, Khadjibaev F.A.

1, Tilemisov S.A.

2

1 Tashkent Medical Academy; 2, Farobe str., Tashkent, 100193, Uzbekistan

2 Republican Scientific Center of Emergency Medical Aid; 2, Farhad str., Tashkent, 100115, Uzbekistan

Aim. To assess the clinical efficiency of biliodigestive and biliobiliary anastomoses with the use of external frame in

patients with extrahepatic bile ducts diseases.

Materials and Methods. The results of examination and treatment of 102 patients were analyzed. The control group

included 60 patients who underwent conventional biliodigestive and biliobiliary anastomoses, the main group comprised

of 42 patients who underwent anastomoses with the use of external metallic circle framework.

Results. Early postoperative complications were observed in 15 (25%) patients of the control group and in 6 (14.3%)

patients of the main group. Different late postoperative complications occurred in 12 (20%) patients of the control group

and in 4 (9.5%) patients of the main group. In the long�term, anastomosis stricture relapse occurred in 4 (6.7%) patients

of the control group, with no relapse observed in the main group.

Conclusion. Biliodigestive anastomoses with the use of external metallic frame carry all the advantages of changeable

transhepatic drainages, while preventing their major potential flaws, such as hemobilia, bile leakage into the abdominal

cavity, increased risk of cholangitis, scar tissue formation in the anastomosis area, stricture relapse after drainage

removal, physical and moral suffering of the patient. Use of external metallic frame does not complicate anastomotic

technique, and provides lower rates of early and late postoperative complications.

Key words: extrahepatic bile ducts, biliodigestive anastomisis, biliobiliary anastomosis, stricture.

Karimov Shavkat Ibragimovich – Doct. of Med. Sci., Professor, the Head of Tashkent Medical Academy, Academician of the

Academy of Sciences. Khakimov Murad Shavkatovich – Doct. of Med. Sci., Professor, Chair of Faculty and Surgery Hospital of

the Medical Faculty of the Tashkent Medical Academy. Khadjibaev Farhod Abdukhakimovich – Cand. of Med. Sci., Postgraduate

of Faculty and Surgery Hospital of the Medical Faculty of the Tashkent Medical Academy. Telemisov Sultan Angarbaevich –

Surgeon of Emergency Surgery Department № 1 of the Republican Research Centre of Emergency Medicine.

For correspondence: Khadjibaev Farhod Abdukhakimovich – 2, Farhod str., Tashkent,100015, Uzbekistan.

Phone: 8�371�150�46�19, 998�90�185�03�64. E�mail: [email protected]

References1. Alidjanov F.B., Aripova N.U. Types of the reconstructive interventions at high strictures of hepaticoholedoch. Annaly khirurgicheskoy gepa�

tologii. 2008; 13 (3):104–105. (In Russian)

2. Galperin E.I., Vetshev P.S. Rukovodstvo po khirurgii zhelchnyh putej [The guidance on the surgery of bile ducts]. Moscow, 2006. 568 p. (In

Russian)

3. Ponchon Т., Baillie J. An Elderly man with a postcholecystectomy bile deak. Endoscopy. 2000; 32: 585–588.

4. Galperin E.I., Chevokin A.Yu., Kuzovlyov N.F. Diagnostics and treatment of the different types of the high scarry strictures of hepatic

ducts. Khirurgia. 2004; 5: 26–31. (In Russian) PMID:15159756

5. Khalzov A.V., Anishenko V.V. The choice of operative treatment type at iatrogenic injury of anhepatic bile ducts. Annaly khirurgicheskoy

gepatologii. 2007; 12 (3): 119–121. (In Russian)

6. Aikossy P., Toth P., Kovacs L. New reconstructive surgery of remnant pancreas in cases of cancer of Pater's papilla. Hepato�Gastroenterology.

2002; 49 (43): 255–257. PMID:11941969

7. Nazirov F.G., Khadjibaev A.M., Altiev B.K. Operations at the injuries and strictures of the bile ducts. Khirurgia. 2006; 4: 46–52. (In

Russian) PMID:16710224

8. Panchenkov D.N., Mamaligina L.A. Iatrogenic injuries of anhepatic bile ducts: diagnostics and surgical tactics on the modern stage. Annaly

khirurgicheskoy gepatologii. 2004; 9 (1): 156–163. (In Russian)

9. Shtofin S.G., Anishenko V.V. Surgical treatment of anhepatic bile ducts injuries. Annaly khirurgicheskoy gepatologii. 2006; 11 (1): 41–44.

(In Russian)

10. Chernishev V.N., Romanov V.E. Povrezhdenija i rubcovye suzhenija zhelchnyh protokov [Injuries and scarry strictures of the bile ducts].

Samara, 2001. 208 p. (In Russian)

11. Tocchi A., Mazzon G., Liotta G. Management of benign biliary strictures biliary enteric anastomosis with endoscopic stenting. Arch. Surg.

2000; 135 (2): 153–157. PMID:10668872

12. Ward J., Sheridan M.B., Guthrie J.A., Davies M.H., Millson C.E., Lodge J.P., Pollard S.G., Prasad K.R., Toogood G.J., Robinson P.J. Bile

duct strictures after hepatobiliary surgery: assessment with MR cholangiopancreatography. Radiology. 2004; 231 (1): 101–108.

PMID:14990819

18


Key words: postcholecystectomy syndrome, sphincter of Oddi dysfunction, dynamic hepatobiliary scintigraphy, duodenum,

dyskinesia, duodenogastric reflux.

BILE DUCTS

Diagnosis of Oddi Sphincter Dysfunction and Duodenal DyskinesiaDiagnosis of Oddi Sphincter Dysfunction and Duodenal Dyskinesiain Patients with Postcholecystectomy Syndromein Patients with Postcholecystectomy Syndrome

Repin M.V., Popov A.V., Mikriukov V.Y., Repin V.N.

E.A. Vagner Perm State Medical Academy; 26, Petropavlovskaya str., Perm, 614990, Russian Federation

Aim. To assess sphincter of Oddi and duodenum function in the long term after cholecystectomy for substantiation of

a treatment tactics.

Material and Methods. The study comprised 109 patients with postcholecystectomic syndrome, excluding those with

jaundice or laboratory signs of cholestasis. Diagnostic tests included esophagogastroduodenoscopy, stomach and duode�

num X�ray evaluation, liver and biliary tract ultrasound imaging. Examination also included dynamic hepatobiliary

scintigraphy with 99m

Тс and choleretic test. Liver, extrahepatic bile ducts, and sphincter of Oddi function as well as duo�

denogastric reflux degree were estimated.

Results. Timely emptying of the common bile duct, starting simultaneously with choleretic test initiation, was observed

in 21 (19.2%) patients. Signs of impeded common bile duct emptying occurred in 8 (7.3%) patients. They were diag�

nosed with stenosis of major duodenal papilla or cholelithiasis which made up indications for surgery. Sphincter of Oddi

incompetence was discovered in 80 (72%) patients, characterized with early discharge of the isotope into the duodenum

before the initiation of choleretic test. This group of patients was marked by predominance of motility and evacuation

disorders of the duodenum which manifested with retrograde peristalsis, duodenogastric, and gastroesophageal reflux.

Dilation of the common bile duct observed in half of these patients was correlated with the severity of duodenal dyski�

nesia and duodenogastric reflux degree.

Conclusion. Dynamic hepatobiliary scintigraphy anables to obtain an objective assessment of biliary flow and duodenum

passage. The largest group among patients with postcholecystectomy syndrome without distinct signs of cholestasis con�

sists of those with the incompetence of the sphincter of Oddi. Cases of sphincter of Oddi incompetence associated with

motility and evacuation disorders are of the most clinical significance, which should be taken in consideration when

choosing therapy.

Repin Maksim Vasilyevich – Doct. of Med. Sci., Professor of Chair of Surgery of Postgraduate Education of E.A. Vagner Perm

State Medical Academy. Popov Alexander Vladimirovich – Doct. of Med. Sci., Chair of Hospital Surgery of E.A. Vagner Perm

State Medical Academy. Mikriukov Viacheslav Iurevich – Postgraduate, Chair of Surgery of Postgraduate Education of

E.A. Vagner Perm State Medical Academy. Repin Vasiliy Nikolaevich – Doct. of Med. Sci., Professor of Chair of Faculty Surgery

№2 with the Сourse of Hematology and Transfusiology of E.A. Vagner Perm State Medical Academy.

For correspondence: Repin Maksim Vasilyevich – Apt. 4, 46 Arhitektora Sviyazeva str., Perm, 614012, Russian Federation.


References1. Pantsirev Y.M., Shapovalyants S.G., Chernyakevich S.A., Pankov A.G., Babkova I.V., Orlov S.Y., Zubova N.V. Functional disorders of the

sphincter of Oddi after cholecystectomy. Rossijskij zhurnal gastrojenterologii, hepatologii, koloproktologii. 2011; 21 (3): 28–34. (In Russian)

2. Ovchinnikov V.A., Bazaev A.V., Goshadze K.A. About eligibility of diagnosis “postcholecystectomy syndrome” in surgery. Almanah

Instituta khirurgii imeni A.V. Vishnevskogo. 2011; 6: 67–68. (In Russian)

3. Prudkov M.I. Classification of diseases, united by the term “postcholecysteсtomy syndrome”. Almanah Instituta khirurgii imeni A.V.

Vishnevskogo. 2011; 6: 70–71. (In Russian)

4. Drossman D.A. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006; 130 (5): 1377–1390. PMID:

16678553.

5. Cicala M., Habib F.I., Vavassori P., Pallotta N., Schillaci O., Costamagna G., Guarino M.P., Scopinaro F., Fiocca F., Torsoli A., Corazziari

E. Outcome of endoscopic sphincterotomy in postcholecystectomy patients with sphincter of Oddi dysfunction as predicted by manome�

try and quantitative choledochoscintigraphy. Gut. 2002; 50 (5): 665–668. PMID: 11950813.

6. Mallery J.S., Baron T.H., Dominitz J.A., Goldstein J.L., Hirota W.K., Jacobson B.C., Leighton J.A., Raddawi H.M., Varg J.J. 2nd

, Waring

J.P., Fanelli R.D., Wheeler�Harbough J., Eisen G.M., Faigel D.O. Complications of ERCP. Gastrointest. Endosc. 2003; 57 (6): 633–638.

PMID: 12709688.

7. Freeman M.L., Nelson D.B., Sherman S., Haber G.B., Herman M.E., Dorsher P.J., Moore J.P., Fennerty M.B., Ryan M.E., Shaw M.J.,

Lande J.D., Pheley A.M. Complications of endoscopic biliary sphincterotomy. N. Engl. J. Med. 1996; 335 (13): 909–919. PMID: 8782497.

8. Repin M.V., Mikryukov V.Y., Popov A.V., Vagner T.E. Quantitative hepatobiliary scintigraphy in post�cholecystectomy patients with a sus�

pected sphincter of Oddi dysfunction. Gut. 2012; 61 (Suppl. 3): A 231.

19


9. Bagnenko S.F., Kabanov M.Y., Yakovleva D.M., Degtyarev D.B., Pirlekov D.R., Kradenov A.V., Bunin V.A. Optimization of the compli�

cated by choledocholithiasis bile�stones disease management strategy. Vestnik Rossijskoj voenno�medicinskoj akademii. 2011; 3: 35–42. (In

Russian)

10. Craig A.G., Peter D.G., Saccone T.P., Ziesing P., Wycherley A., Toouli J. Scintigraphy versus manometry in patients with suspected bil�

iary sphincter of Oddi dysfunction. Gut. 2003; 52 (3): 352–357. PMID: 12584215.

11. Jagannath S., Kalloo A.N. Efficacy of biliary scintigraphy in suspected sphincter of Oddi dysfunction. Curr. Gastroenterol. Rep. 2001; 3 (2):

160–165. PMID: 11276385.

12. Madacsy L., Middelfart H.V., Matzen P., Hojgaard L., Funch�Jensen P. Quantitative hepatobiliary scintigraphy and endoscopic sphincter

of Oddi manometry in patients with suspected sphincter of Oddi dysfunction: assessment of flow�pressure relationship in the biliary tract.

Eur. J. Gastroenterol. Hepatol. 2000; 12 (7): 777–786. PMID: 10929906.

20


BILE DUCTS

Pharmacological Correction of Biliary Outflow Pharmacological Correction of Biliary Outflow in Patients with Biliary Tract Malignanciesin Patients with Biliary Tract Malignancies

Yakovlev A.Y.1, Zaitsev R.R.

1, Semyonov V.B.

1, Niyazmatov A.A.

1,

Zakharov A.G.1, Chichkanova A.S.

2, Akulenko S.V.

1, Vorontsov A.Y.

2, Ulitin D.N.

2

1 GBUZ “N.A. Semashko Nizhny Novgorod Regional Clinical Hospital”; 190, Rodionova str., Nizhny Novgorod,

603126, Russian Federation2 GBUZ “Regional Oncology Center of Nizhny Novgorod”; 190, Rodionova str., Nizhny Novgorod, 603126,

Russian Federation

Aim. To determine the role of pharmacological correction of hepatic dysfunction with Heptral in patients with biliary

tract malignancies after ultrasound�controlled external drainage of the biliary tract.

Materials and Methods. The study was conducted in 43 patients. Group 1 consisted of 23 patients who received 800 mg

per day dose of Heptral in addition to infusion therapy within 10 days after external drainage of the biliary tract. Group 2

consisted of 20 patients who received conventional infusion. Tests were performed to measure levels of serum bilirubin,

alanine aminotransferase, alkaline phosphatase and gamma�glutamyl transpeptidase.

Results. Shortening of postoperative liver failure compensation period was observed in patients treated with Heptral. On

day 4, the volumes of externally drained bile were significantly larger for Group 1 patients. On day 10 total and direct

bilirubin concentrations in Group 1 patients have dropped to a level eligible for drug therapy of primary cancer. Decrease

in alanine aminotransferase activity in patients of Group 1 provided for statistically significant inter�group difference on

day 8 of postoperative therapy. Reestablishment of biliary outflow allowed to decrease cholestataic damage of hepato�

cytes which was reflected by lower activity of alkaline phosphatase, gamma�glutamyl transpeptidase, and lower

lipopolysaccharide levels. Statistically significant inter�group differences for these values were achieved on day 6 after

starting Heptral therapy.

Conclusion. The use of Heptral after ultrasound�controlled external drainage of the biliary tract in patients with hepato�

biliary malignancies provides significant shortening of liver detoxification and excretory functions repair period by alle�

viating cholestatic and cytolytic syndromes in acute liver failure.

Key words: mechanical jaundice, bilirubin, choledochostomy, Heptral.

Yakovlev Alexey Yurevich – Doct. of Med. Sci., Associate Curator of Resuscitation GBUZ BUT “N.A. Semashko Nizhny

Novgorod Regional Clinical Hospital”. Zaitsev Roman Romanovich – Surgeon Endoscopic Surgery Center of Resuscitation

GBUZ BUT “N.A. Semashko Nizhny Novgorod Regional Clinical Hospital”. Semyonov Vladimir Borisovich – Cand. of Med.

Sci., Head of the Intensive Care of Resuscitation GBUZ BUT “N.A. Semashko Nizhny Novgorod Regional Clinical Hospital”.

Niyazmatov Agzam Ahtamovich – Doctor of the Department of Clinical and Laboratory Diagnostics of Resuscitation GBUZ

BUT “N.A. Semashko Nizhny Novgorod Regional Clinical Hospital”. Zakharov Alexei Gennadievich – Head of the Department

of Surgery of the Liver and Pancreas of Resuscitation GBUZ BUT “N.A. Semashko Nizhny Novgorod Regional Clinical

Hospital”. Chichkanova Angelina Semenovna – Doctor Chemoterapeutist GBUZ BUT “Nizhny Novgorod Regional Cancer

Center”. Akulenko Sergey Vladimirovich – Cand. of Med. Sci., Surgeon Department of Surgery of the Liver and Pancreas GBUZ

BUT “NA Semashko Nizhny Novgorod Regional Clinical Hospital”. Vorontsov Alexey Yurevich – Cand. of Med. Sci., Head of

the Surgical Department GBUZ 1 BUT “Nizhny Novgorod Regional Cancer Center”. Ulitin Dmitri Nikolaevich – Surgeon

1 Surgical Department of GBUZ 1 BUT “Nizhny Novgorod Regional Cancer Center”.

For correspondence: Yakovlev Alexey Yurevich – apt. 26A, 3, Komsomolskaya str., Nizhny Novgorod, 603043, Russian

Federation. Phone: 8�831�438�93�33, 8�903�608�57�37. E�mail: [email protected]

References1. Savel'ev V.S. 80 lekcij po khirurgii [80 lectures on surgery]. Moscow: Litterra, 2008. 910 p. (In Russian)

2. Galperin E.I., Vetshev P.S. Rukovodstvo po khirurgii zhelchnyh putej [Manual for surgery of the biliary tract]. Moscow: Vidar, 2006. 559 p.

(In Russian)

3. Ivshin V.G., Jakunin A.Ju., Makarov Ju.I. Percutaneous transhepatic diagnostic and therapeutic interventions in patients with obstructive

jaundice. Annaly khirurgicheskoy gepatologii. 1996; 1 (1): 121–131. (In Russian)

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2009. Vol. 1. 960 p. (In Russian)

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12418503.

21


7. Martinez�Chantar M.L., Garcia�Trevijano E.R., Latasa M.U., Perez�Mato I., Sanches del Pino M.M., Corrales F.G., Avita M.A., Mato

J.M. Importance of a deficiency in S�adenosyl�L�methionine synthesis in the pathogenesis of liver injury. Am. J. Clin. Nutr. 2002; 76 (5):

1177–1182. PMID: 12418501.

8. Cederbaum A.I. Hepatoprotective effects of S�adenosyl�L�methionine against alcohol� and cytochrome P450 2E1�induced liver injury.

World J. Gastroenterol. 2010; 16 (11): 1366–1376. PMID: 20238404.

9. Bondarenko V.M., Likholed V.G. Interaction of gut microflora with Toll�like receptors in norm and pathology. Immunologija. 2009; 5:


10. Aleshukina A.V. Pathogenesis of intestinal dysbiosis. Zhurnal mikrobiologii, epidemiologii i immunobiologii. 2012; 3: 74–78. (In Russian)

11. Fialkina S.V., Bekbauvov S.A., Maznica D.A. Intestinal microbiocenosis in obstructive jaundice caused by occlusion of the bile ducts.

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and septic shock: a possible role for specific anti�endotoxin therapy? Contrib. Nephrol. 2010; l67: 102–110. DOI: 10.1159/000315924;

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14. Panchenko L.F., Pirozhkov S.V., Terebilina N.N., Naumova T.A., Baronec V.Ju., Shojbonov T.B. Antiendotoxin mechanisms protect the

liver. Patologicheskaja fiziologija i eksperimental'naia terapia. 2012; 3: 62–69. (In Russian)

22


PANCREAS

Correction of Regional Blood Flow in Combined Therapy Correction of Regional Blood Flow in Combined Therapy of Acute Pancreatitis Patientsof Acute Pancreatitis Patients

Lubyanskii V.G., Arutyunyan G.A., Aliev A.R., Zharikov A.N.

Chair of Hospital Surgery of Altai State Medical University of Russian Federation Healthcare Ministry;

40, prospect Lenina, Barnaul, Altai region, 656038, Russian Federation

Aim. To assess the feasibility of regional intravascular therapy with “microcirculation deblocking” drugs in patients with

pancreonecrosis.

Materials and Methods. 106 patients with pancreonecrosis were divided into three groups. The first group included

71 patients; 20 (28%) patients with sterile and 51 (72%) patients with infected pancreonecrosis. The second group con�

sisted of 23 patients receiving combine treatment extended with prolonged intra�arterial infusion of antibiotics and dis�

aggregants into celiac trunk in order to improve blood circulation and stimulate microvascular flow. In this group sterile

and infected pancreonecrosis was observed in 9 (39%) and 14 (61%) patients respectively. The third group included

12 patients with pancreanecrosis which earlier had received prolonged intra�arterial infusion of alprostadil in combina�

tion with antibiotics. In this group sterile and infected pancreonecrosis was observed in 9 (75%) and 3 (25%) patients

respectively. The prolonged intra�arterial infusion was performed selectively via pancreatic arteries.

Results. In the first group 47 (67%) patients underwent surgery. Average treatment duration and mortality were 35.8 ± 2.3

days and 16.9% respectively. In the second group 10 (43%) patients underwent surgery and average treatment duration

was 24.8 ± 3.6 days. There were no lethal outcomes. In the third group surgery was needed only in 2 (16.7%) cases, aver�

age treatment duration was 23.6 ± 2.1 and no lethal outcomes occurred.

Conclusion. Regional intravascular infusion of alprostadil improves blood circulation in pancreatic parenchyma and

stimulates encapsulation with early fluid collections formation and decrease in peripancreatic infiltration and infection.

Key words: pancreas, pancreonecrosis, microcirculation, prolonged intra�arterial infusion, alprostadil.

Lubyanskii Vladimir Grigorjevich – Doct. of Med. Sci., Professor, Head of Chair of Hospital Surgery AGMU. Arutyunyan HenryAlexandrovich – Postgraduate of same Chair. Aliev Aleksandr Rushtievich – Cand. of Med. Sci., Assistant Professor of same Chair.

Zharikov Andrei Nikolaevich – Cand. of Med. Sci., Assistant Professor of same Chair.

For correspondence: Arutyunyan Henry Alexandrovich – Apt. 36, 37, Trudovoy lane, Barnaul, 656038. Phone: 8�923�645�47�77.


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264 p. (In Russian)

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Medicine, 1989. 369 p. (In Russian)

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28 (9): 1301–1311.

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8. Vinnik Ju.S., Cherdancev D.V., Vahrunin A.A., Fattahov V.L., Jakimov S.V., Pervova O.V. Diagnostika narushenij mikrogemodinamiki pri

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9. Zatevahin I.I., Ciciashvili M.Sh., Budurova M.D., Altunin A.I. Pankreonekroz (diagnostika, prognozirovanie i lechenie): monografija.

[Pancreatonecrosis (diagnosis, prognosis and treatment): monograph]. Moscow, 2007. 224 p. (In Russian)

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Pancretic necrosis configuration and differentiated management of acute pancreatitis. Annaly khirurgicheskoy gepatologii. 2013; 18 (1):


23


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24


PANCREAS

No�touch Isolation of Pancreas: How I do itNo�touch Isolation of Pancreas: How I do itPart 1. Proximal ResectionPart 1. Proximal Resection

Egiev V.V.

Federal Мedical Rehabilitation Center; 3, Ivankovsky highway, Moscow, 125367, Russian Federation

The article introduces a variant of pancreatoduodenal complex mobilization which belongs to “no�touch” approach.

It also presents an analysis of different variants of mobilization with early identification and transection of arteries, sup�

plying proximal part of the pancreas, which have recently appeared in literature. The literature review shows the “no�

touch” isolation method to be a quite promising approach for performing more radical surgery.

Key words: pancreas, cancer, pancreatoduodenal resection, no�touch, artery first, long�term outcomes.

Egiev Valeriy Nicolaevich – Doct. of Med. Sci., Professor, Chief Surgeon of Federal Medical Rehabilitation Center.

For correspondence: Egiev Valeriy Nicolaevich – 3, Ivankovsky highway, Moscow, 125367, Russian Federation.


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(In Russian)

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doi: 10.1002/jhbp.54.

16. Shah O.J., Gagloo M.A., Khan I.J., Ahmad R., Bano S. Pancreaticoduodenectomy: a comparison of superior approach with classical

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17. Kurosaki I., Minagawa M., Takano K., Takizawa K., Hatakeyama K. Left posterior approach to the superior mesenteric vascular pedicle

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1993; 40 (5): 426–429. PMID: 8270230.

19. Shukla P.J., Barreto G., Pandey D., Kanitkar G., Nadkami M.S., Neve R., Shrikhande S.V. Modification in the technique of pancreatico�

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18019705.

25


20. Hackert T., Werner J., Weitz J., Shmidt J., Buchler M.W. Uncinate process first�a novel approach for pancreatic head resection. Lang. Arch.

Surg. 2010; 395 (8): 1161–1164. doi: 10.1007/s00423�010�0663�9. PMID: 20582600.

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Hepatogastroent. 2001; 48 (38): 372–374. PMID: 11379311.

22. Pessaux P., Rosso E., Panaro F., Marzano E., Oussoultzoglou E., Bachellier P., Jaeck D. Preliminary experience with the hanging maneu�

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23. Shrikhande S.V., Barreto S.G., Bodhankar Y.D., Suradkar K., Shetty G., Hawaldar R., Goel M., Shukla P.J. Superior mesenteric artery first

combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating

perioperative outcomes. Lang. Arch. Surg. 2011; 396 (8): 1205–1212. doi: 10.1007/s00423�011�0824�5.

24. Kawabata Y., Tanaka T., Nishi T., Monma H., Yano S., Tajima Y. Appraisal of a total meso�pancreatoduodenum excision with pancreati�

coduodenectomy for pancreatic head carcinoma. EJSO. 2012; 38 (7): 574–579. doi: 10.1016/j.ejso.2012.04.007. PMID: 22575529.

25. Gaedcke J., Gunawan B., Grade M., Szoke R., Liersch T., Becker H., Ghadimi B.M. The mesopancreas is the primary site for R1 resec�

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PMID: 19418067.

26. Kitagawa H., Tajima H., Nakagawara H., Hayashi H., Makito I., Takamura H., Ninomiya I., Fushida S., Kayahara M., Ohta T., Ikeda H.

The retropancreatic fusion fascia acts as s barrier against infiltration by pancreatic carcinoma. Mol. Cl. Oncol. 2013; 1 (3): 418–422. PMID:

24649185.

27. Esposito I., Kleeff J., Bergmann F., Reiser C., Herpel E., Friess H., Schirmacher P., Buchler M.W. Most pancreatic cancer resections are

R1 resections. Ann. Surg. Oncol. 2008; 15 (6): 1651–1660. doi: 10.1245/s10434�008�9839�8. PMID: 18351300.

28. Bockhorn M., Cataldegirment G., Kutup A., Marx A., Burdelski C., Vashist J.K., Mann O., Liebl L., Konig A., Izbicki J.R., Yekebas E.F.

Crossing the rubicon: when pancreatic resection with curative intent ends in an R2 status. Ann. Surg. Oncol. 2009; 16 (5): 1212–1221. doi:

10.1245/s10434�009�0363�2. PMID: 19225843.

29. Nagai S., Fujii T., Kodera Y., Kanda M., Sahin T.T., Kanzaki A., Yamada S., Sugimoto H., Nomoto S., Takeda S., Morita S., Nakao A.

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and outcome in resected pancreatic cancer. J. Clin. Oncol. 2009; 27 (17): 2855–2862. doi: 10.1200/ JCO.2008.20.5104. PMID: 19398572.

26


PANCREAS

Antibiotic Prophylaxis and Therapy of Infected Pancreatic Antibiotic Prophylaxis and Therapy of Infected Pancreatic Necrosis Adjusted for Gastric Microbial IndicatorsNecrosis Adjusted for Gastric Microbial Indicators

Fomin A.V.1, Okulich V.K.

2, Ovsianik D.M.

1

1 Chair of Faculty Surgery and

2Chair of Clinical Microbiology of Vitebsk State Order of Peoples' Friendship

Medical University Ministry of Healthcare of Belarus; 27, Frunze Avenue, Vitebsk, 210023, Republic of Belarus

Aim. To study changes of the gastric microbial indicators in pancreatitis and to evaluate the potential of bacteriological

examination of gastric contents for early diagnosis, prevention and treatment of infected pancreatic necrosis.

Materials and Methods. 66 patients with various forms of acute pancreatitis were examined. Level of microbial contam�

ination of gastric contents was determined by the Gould method. Species composition of the microflora of the stomach,

peritoneal exudate, fluid collections punctates were established by using test kits with automated biochemical analyzer,

antibiotic sensitivity was tested with disk diffusion method.

Results. Developing of infection in the setting of pancreatic necrosis was accompanied with violation of microflora of

the gastric contents and the sharp increase in contamination level, reaching 1 × 106 CFU/mL or higher. In 72.2% of cases

microflora of the gastric contents was proved to be similar with the one identified in the zones of necrosis of pancreas

and retroperitoneal fat tissue.

Sensitivity of this method of determining pathogenic microorganisms in infected pancreatic necrosis by microbial exam�

ination of gastric contents was 70.3%, specificity – 93.2%, accuracy – 89.2%. Antibiotic prophylaxis and therapy of

infected pancreatic necrosis adjusted for gastric contents indicators allowed to reduce severity of this condition in 75%

of patients. Mortality rate (12.5%) was 1,4 times lower than in patients who received standard therapy.

Conclusion. Microbial examination of gastric contents in patients with pancreatic necrosis may enhance early diagnosis

of septic complications, increase the potential for rational antibiotic prophylaxis and therapy of infected pancreatic

necrosis, and improve treatment outcomes.

Key words: acute pancreatitis, infected pancreatic necrosis, early diagnosis, antibiotic prophylaxis, antibiotic therapy, micro�

bial examination.

Fomin Anatoly Viktorovich – Doct. of Med. Sci., Professor of Chair of Faculty Surgery, Vitebsk State Medical University.

Okulich Vitaly Konstantinovich – Cand. of Med. Sci., Docent of Chair of Clinical Microbiology of Vitebsk State Medical

University. Ovsianik Dmitry Mechislavovich – Postgraduate, Chair of Faculty Surgery of Vitebsk State Medical University.

For correspondence: Ovsianik Dmitry Mechislavovich – Apt. 64, 25�2, Chkalova str., Vitebsk, 210032, Republic of Belarus.

Phone: +37529�216�91�65. E�mail: [email protected]

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antibiotic treatment in acute necrotising pancreatitis. Lancet. 1995; 346 (8976): 663–667. DOI: 10.1016/S0140�6736(95)92280�6. PMID:

7658819.

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ual in 3 vols, ed. Saveliev V.S., Kiriyenko A.I.]. Moscow: GEOTAR�Media, 2009. V. II. 832 p. (In Russian)

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P.G. [Differential diagnosis and treatment of surgical diseases. Manual of Clinical Surgery, ed. Kondratenko P.G.]. Donetsk: Novy mir,

2005. 752 p. (In Russian)

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creatic necrosis, etiology, pathogenesis, microbial landscape treatment. Bjulleten' Vostochno�Sibirskogo nauchnogo centra SO RAMN. 2011;

80 (4), Part 2: 162–168. (In Russian)

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Borges, 2011. 99 p. (In Russian)

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27


10. Savelyev V.S., Filimonov M.I., Gelfаnd B.R., Burnevich S.Z. Destructive pancreatitis. Standards for diagnosis and treatment: the project

is based on materials IX All�Russian Congress of Surgeons, comp. 20–22 September 2000 in Volgograd. Annaly khirurgicheskoy gepatologii.

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acute pancreatitis]. Chita: IPC CHGMA, 2008. 160 p. (In Russian)

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atitis. Manual for Physicians ed. Nedashkovsky E.V.]. Moscow: GEOTAR�Media, 2009. 272 p. (In Russian)

15. Fomin A.V., Ovsianik D.M. Sposob opredelenija patogennoj mikroflory pri inficirovannom pankreonekroze. MPK A 61V 17/00 / zajavitel'

Vitebskij gos. med. un�t. – zajavl. № a 20120437; opubl. 30.10.13 [A method for determining the pathogenic microflora in infected necro�

tizing pancreatitis. IPC A 61B 17/00 / applicant Vitebsk State. Med. Univ. – Appl. Number a 20120437 and publ. 30.10.13. Aficiyny

byuleten: Vynahodstvy. Karysnyya madeli. Pramyslovya uzory / Nac. centar intelektual. ulasnasci. 2013; 5: 12].

16. Karpov O.E., Stoyko Y.M., Zamyatin M.N., Levchuk A.L., Teplyh B.L., Gusarov V.G. Protokol obsledovanija i lechenija bol'nyh ostrym

pankreatitom. Metodicheskie rekomendacii pod red. Shevchenko Ju.L. [The examination and treatment protocol for acute pancreatitis

patients. Guidelines ed. Shevchenko Y.L.]. Moscow, 2010. 22 p. (In Russian)

28


CASE REPORTS

Arterial Reconstruction in Patients Arterial Reconstruction in Patients with Proper Hepatic Artery Aneurysm with Proper Hepatic Artery Aneurysm

Novruzbekov M.S., Guliaev V.A., Olisov O.D., Lutsik K.N.,

Muslimov R.Sh., Magomedov K.M., Driaev V.T., Chernaya N.R.

N.V. Sklifosovskiy Scientific & Research Institute of Emergency; 3, B. Sukharevskaya sq.,

Moscow, 129010, Russian Federation

Hepatic artery aneurisms comprise about 20% of all aneurysms affecting unpaired abdominal vessels. Invasive celiaco�

graphy and spiral computed tomography play the leading role in diagnosis of these lesions. Intrahepatic localization and

small aneurysm size are indications for endovascular treatment. Surgical treatment is indicated in proper hepatic artery

aneurysms as well as large�sized aneurysms.

Key words: hepatic artery aneurysm, arterial reconstruction.

Novruzbekov Murad Saftarovich – Cand. of Med. Sci., Chief of Liver Surgery Department of Sklifosovsky Research Institute for

Emergency Medicine. Guliaev Vladimir Alekseevich – Cand. of Med. Sci., Leading Researcher of Kidney Transplantology

Department of Sklifosovsky Research Institute for Emergency Medicine. Olisov Oleg Danielovich – Cand. of Med. Sci.,

Associate Senior Researcher of the Liver Transplantology Department of Sklifosovsky Research Institute for Emergency

Medicine. Lutsik Konstantin Nikolaevich – Cand. of Med. Sci., Head of the Liver Transplantology Department of Sklifosovsky

Research Institute for Emergency Medicine. Muslimov Rustam Shahismailovich – Cand. of Med. Sci., Leading Researcher of

Radiology Department of Sklifosovsky Research Institute for Emergency Medicine. Magomedov Kubai Magomedovich –

Surgeon of the Liver Surgery Department of Sklifosovsky Research Institute for Emergency Medicine. Driaev VladimirTaimurazovich – Surgeon of the Liver Transplantology Department of Sklifosovsky Research Institute for Emergency Medicine.

Chernaya Natalia Resovna – Cand. of Med. Sci., Associate Senior Researcher of Intervetional Medicine Department of

Sklifosovsky Research Institute for Emergency Medicine.

For correspondence: Olisov Oleg Danielovich – 3/5, B. Sukharevskaya sq., Moscow, 129090. Phone: 8�495�628�35�02.


References1. Zatevaxin I.I., Tsitsiashvili M.Sh., Zolkin V.N., Sidelceva A.A. Hepatic artery aneurysm rupture associated with duodenal fistula forming.


2. Tarazov P., Ryzhkov V., Polysalov V., Prozorovskij K., Polykarpov A. Extraorganic hepatic artery aneurysm: failure of transcatheter

embolization. HPB Surgery. 1998; 11 (1): 55–59. PMID: 9830583.

3. O'Driscoll D., Olliff, S.P., Olliff. J.F. Hepatic artery aneurysm. Br. J. Radiol. 1999; 72 (862): 1018–1025. PMID: 10673957.

4. Jaunoo S.S., Tang T.Y., Uzoigwe, C., Walsh S.R., Gaunt M.E. Hepatic artery aneurysm repair: a case report. J. Med. Case Reports. 2009;

3: 18. doi: 10.1186/1752�1947�3�18. PMID: 19159439.

5. Man C.B., Behranwala K.A., Lennox M.S. Ruptured hepatic artery aneurysm presenting as abdominal pain: a case report. Cases J. 2009;

2: 8529 . doi: 10.4076/1757�1626�2�8529. PMID: 19918380.

6. Dogan R., Yildirim E., Gokturk S. Gastrointestinal hemorrage caused by rupture of pseudoaneurysm of the hepatic artery. Turk J.

Gastroenterol. 2012; 23 (2): 160–164. PMID: 22706745.

7. Shiarishi M., Takahashi M., Yamaguchi A., Adachi H. Hepatic artery pseudoaneurysm with extrahepatic biliary obstruction. Ann. Vasc. Dis.

2012; 5 (1): 100–103. doi: 10.3400/avd.cr.11.00080. PMID: 23555497.

8. Chen W.C., Frennete C. Hepatic artery pseudoaneurysm: a rare cause of gastrointestinal bleeding in a post liver transplant patient. J.

Gastrointestin. Liver Dis. 2012; 21 (2): 125. PMID: 22720296.

9. Zhang A., Xu Z., Zhang M., Zheng S. Successful superselective embolization of posttraumatic pseudoaneurysm of replaced hepatic artery

in a child with situs inversus totalis. Chin. Med. J. 2007; 120 (16): 1465–1467. PMID: 17825182.

10. Kemezh Yu.V., Eremeicheva A.Yu. Aneurisms of abdominal aorta visceral branches as diagnostic findings during abdominal CT.

Klinicheskaya practica. 2011; 2: 65–70. (In Russian)

11. Lesnyak V.M., Kemezh Yu.V., Eremeicheva A.Yu. CT�diagnostics of visceral branches of abdominal aorta aneurisms. Rossijskij Jelektronnyj

Zhurnal Luchevoj Diagnostiki. 2011; 1 (3): 69–74. (In Russian)

12. Nishibe M., Nishibe T., Koizumi J., Kondo Y., Dadrik A., Sato K., Ogino H. Surgical treatment of a dissecting aneurysm of the proper

hepatic artery: report of a case. Ann. Thorac. Cardiovasc. Surg. 2013; 19 (4): 326–329. PMID: 23232260.

29


CASE REPORTS

A Rare Diverse Complication of CholelithiasisA Rare Diverse Complication of Cholelithiasis

Kulchiev A.A.1, Morozov A.A.

1, Tigiev S.V.

1, 2, Karaev T.R.

1

1 North Ossetian State Medical Academy of the Ministry of Healthcare of the Russian Federation; 40,

Pushkinskaya str., Vladikavkaz, 362019, Russian Federation 2 Junction Station Hospital of Vladikavkaz Russian Railways; 16, Chkalov str., Vladikavkaz, 362002,

Russian Federation

The article presents a case report of cholelithiasis complicated with hemobilia. It also provides literature review, high�

lighting current difficulties in diagnosis and preoperative assessment.

Key words: cholelithiasis, hemorrhage, hemobilia.

Kulchiev Ahsarbek Agubeevich – Doct. of Med. Sci., Professor, Head of the Chair of Surgical Diseases No 3 of North Ossetian

State Medical Academy. Morozov Alexey Anatolyevich – Cand. of Med. Sci., Docent, Assistant of the Chair of Surgical Diseases

No 3 of North Ossetian State Medical Academy. Tigiev Severyan Vladimirovich – Cand. of Med. Sci., Head of Surgical

Department of Junction Station Hospital of Vladikavkaz, Assistant of the Chair of Surgical Diseases No 3 of North Ossetian State

Medical Academy. Karaev Taimuraz Ruslanovich – Teaching Assistant, Clinical Resident of the Chair of Surgical Diseases No 3

of North Ossetian State Medical Academy.

For correspondence: Kulchiev Ahsarbek Agubeevich – 26, Titova str., Vladikavkaz, 362002, Russian Federation.

Phone: 8�867�254�62�51. E�mail: [email protected]

References1. Bogdanov A.V. Svishhi pishhevaritel'nogo trakta v praktike obshhego khirurga. 1�e izd. [Digestive fistulas common practice in surgery].

Moscow: Binom, 2001. 197 p. (In Russian)

2. Abramov A.A. Khirurgicheskoe lechenie holecistita i ego oslozhnenij [Surgical treatment of cholecystitis and its complications: author. dis. ...

cand. of med. sci.]. Moscow: Meditsina, 2005. 150 p. (In Russian)

3. Petrov V.P., Erpohin I.A., Shemyakin I.S. Krovotechenija pri zabolevanijah pishhevaritel'nogo trakta [Bleeding in diseases of the digestive

tract]. Moscow: Meditsina, 1987. 256 p. (In Russian)

4. Avdyei L.V., Kosmachev V.I. Hemobilia in injuries and diseases of the liver and biliary tract. Vestnik khirurgii. 1973; 5: 25–30. (In Russian)

5. Shalimov A.A., Radzikhovskiy A.P., Semin M.D., Bobrov O.E., Kurilets I.P. Diagnosis and treatment of hemobilia. Khirurgia. 1984; 2:

27–29. (In Russian). PMID: 6708360.

6. Vantsyan E.N. Naruzhnye i vnutrennie svishhi [External and internal fistulas]. Moscow: Meditsina, 1990. 220 p. (In Russian)

7. Vahidov A.V., Altyev B.K., Artikov B.J. Biliodigestive internal fistulas. Khirurgia. 1993; 10: 78–81. (In Russian) PMID: 8295390.

8. Shalimov S.A., Nichitaylo M.E., Domanski B.V. Khirurgija pecheni i zhelchevyvodjashhih putej [Surgery of the liver and biliary tract]. Kiev:

Zdorovie, 1993. 512 p. (In Russian)

9. Galperin E.I., Dederer Y.M. Nestandartnye situacii pri operacijah na pecheni i zhelchnyh putjah [Unusual situations during operations on

the liver and biliary tract]. Moscow: Meditsina, 1998. 265 p. (In Russian)

10. Komarov N.V., Bagrov N.A., Komarov R.N. Hemobilia in cholelythiasis. Vestnik khirurgii. 1999; 4: 85–86. (In Russian)

11. Ponomarev A.A., Fedoseev A.V. Redkie khirurgicheskie zabolevanija pecheni i zhelchnyh protokov. [Rare surgical diseases of the liver and bile

ducts]. Moscow: MDK, 1999. 447 p. (In Russian)

12. Lokhvitskii S.V. Features of surgical tactics in various forms and cholecysto� holedohodigestiv fistula. Annaly khirurgicheskoy gepatologii.

2006; 11 (3): 99–104. (In Russian).

30


CASE REPORTS

Nine�year Survival Rate after Locoregional Treatment Nine�year Survival Rate after Locoregional Treatment in a Patient with Hepatocellular Carcinomain a Patient with Hepatocellular Carcinoma

Dolgushin B.I., Kosyrev V.Y., Shishkina N.A.

N.N. Blokhin Russian Cancer Research Center. 24, Kashirskoe shosse, Moscow, 115478, Russian Federation

This case report demonstrates the therapeutic capabilities of combination of different minimally in vasiveradiology tech�

niques (transarterial chemoembolization, percutaneous radiofrequency ablation, and percutaneous ethanol injection)

in a patient with inoperable hepatocellular carcinoma.

Key words: hepatocellular carcinoma, percutaneous radiofrequency ablation, percutaneous ethanol injection, transarterial

chemoembolization.

Dolgushin Boris Ivanovich – Doct. of Med. Sci., Professor, Corresponding Member of RAMSci, Deputy Director of N.N. Blokhin

Russian Cancer Research Center, Head of Diagnostic and Interventional Radiology Department of the same Center. KosyrevVladislav Yurievich – Doct. of Med. Sci., Leading Researcher, Laboratory of Interventional Radiology of N.N. Blokhin Russian

Cancer Research Center. Shishkina Nina Anatolievna – Researcher, Laboratory of Interventional Radiology of N.N. Blokhin

Russian Cancer Research Center.

For correspondence: Dolgushin Boris Ivanovich – 24, Kashirskoe shosse, Moscow, 115478. Phone: +7�495�324�60�63,

Fax: +7�495�324�44�96. E�mail: [email protected]

References 1. Zhu A.X., Salem R. Combining transarterial chemoembolization with radiofrequency ablation for hepatocellular carcinoma: One step for�

ward? J. Clin. Oncol. 2013; 31 (4): 406–408. doi: 10.1200/JCO.2012.46.1897. PMID: 23269989.

2. Peng Z.�W., Zhang Y.�J., Chen M.�S., Xu L., Liang H.H., Lin X.J., Guo R.P., Zhang Y.Q., Lau W.Y., Zhang Y.�J., Chen M.�S.

Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma. A

prospective randomized trial. J. Clin. Oncol. 2013; 31 (4): 426–432. doi: 10.1200/JCO.2012.42.9936. PMID: 23269991.

3. Lin S.M., Lin C.J., Lin C.C., Hsu C.W., Chen Y.C. Radiofrequency ablation improves prognosis compared with ethanol injection for

hepatocellular carcinoma < or = 4 см. Gastroenterology. 2004; 127 (6): 1714–1723. PMID: 15578509.

4. Shiina S., Teratani T., Obi S., Sato S., Tateishi R., Fujishima T., Ishikawa T., Koike Y., Yoshida H., Kawabe T., Omata M. A randomized

controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 2005; 129 (1):

122–130. PMID: 16012942.

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Transcatheter arterial chemoembolization with or without radiofrequency ablation in the management of patients with advanced hepatic

malignancy. Am. Surg. 2002; 68 (9): 827–831. PMID: 12356160.

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7. Yamakado K., Nakatsuka A., Akeboshi M., Shiraki K., Nakano T., Takeda K. Combination therapy with radiofrequency ablation and tran�

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Transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann. Surg. Oncol. 2011; 18 (6):

1624–1629. doi: 10.1245/s10434�011�1673�8. PMID: 21445671.

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CASE REPORTS

Double Biliary and Duodenal Stenting Double Biliary and Duodenal Stenting in Stenotic Pancreatic Tumorin Stenotic Pancreatic Tumor

Marinova L.A., Bachurin A.N., Chevokin A.Yu.

Moscow University Hospital No.7; 4, Kolomenskiy proezd, Moscow, 115446, Russian Federation

Minimally invasive surgical techniques for treatment of stenosis of different structures of digestive tract are becoming

more widely used. This case report demonstrates successful recovery of biliary and duodenal patency as a final stage of

palliation in a patient with pancreas head tumor, complicated with occlusion of the duodenum and common bile duct.

Key words: pancreatic cancer, obstructive jaundice, duodenal stenosis, duodenal stenting, biliary stenting with self�expand�

able stent, double stenting.

Marinova Lyudmila Anatolievna – Сand. of Med. Sci., Head of Endoscopy Department, Moscow University Hospital No 7.

Bachurin Alexey Nikolaevich – Endoscopist, Moscow University Hospital No 7. Chevokin Alexandr Yuryevich – Cand. of Med.

Sci., Head of the Surgical Department No.13 of Moscow University Hospital No 7.

For correspondence: Marinova Lyudmila Anatolievna – 4, Kolomenskiy pro’ezd, Moscow, 115446, Russian Federation.


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